Prolapse Of Uterus Research Articles

Changes in elastin-binding protein in fibroblasts derived from cardinal ligaments of patients with prolapsus uteri.

Prolapsus uteri in pelvic supportive disorders are common in elderly women, and their etiology remains unclear. We examined elastin-binding proteins (EBPs) and binding sites in cultured cardinal ligament fibroblasts derived from elderly patients with prolapsus uteri (HPLiF) and compared them with those from age-matched control subjects (HCLiF). Cell attachment to alpha-elastin was significantly lower in HPLiF than in HCLiF. Elastin suppressed the higher proliferative activity at near confluency in HPLiF. The 67-kDa EBP was detectable in HCLiF, whereas HPLiF expressed a 59-kDa EBP. The expression of EBP was significantly lower in HPLiF. The synthetic peptide Val-Gly-Val-Ala-Pro-Gly (VGVAPG), which contains a recognition sequence for the elastin receptor, inhibited the adhesion of HCLiF to alpha-elastin at 10(-5)-10(-4) M, but showed no inhibitory activity on the adhesion of HPLiF at 10(-5) M. These results suggest that fibroblasts derived from elderly women with prolapsus uteri can recognize alpha-elastin through interactions with the low-molecular-size (59-kDa) EBP for the sequence VGVAPG with low affinity and may contribute to the loss of supportive function in uterine connective tissues.

Carcinoma of the Cervix in Association with Uterine Prolapse

Background. Carcinoma of the cervix and a prolapsed uterus are common diseases in underdeveloped countries, but their association is quite rare.Case. We report here the clinical characteristics of two Brazilian patients with carcinoma of the uterine cervix associated with a third-degree prolapsed uterus. The patients, respectively aged 69 and 73 years, were admitted with an ulcerated prolapsed uterus. Biopsy of the ulcerated cervical lesion confirmed epidermoid carcinoma. The patients underwent radical vaginal hysterectomy complemented with external irradiation. The first patient was lost to follow-up, whereas the second is alive, with no signs of disease, 2 years after surgery.Conclusion. When operable invasive cervical carcinoma is found in association with full prolapse, radical vaginal hysterectomy complemented with radiotherapy seems to be an adequate therapeutic option.

骨盤底筋群弛緩症 (子宮脱, 膀胱瘤) を伴い肛門より脱出した直腸肛門管癌の1例

骨盤底筋群弛緩症 (子宮脱, 膀胱瘤) を伴い肛門より脱出した直腸肛門管癌の1例

L’hystérectomie vaginale : à propos d’une sériede 1 008 interventions

Study aim – The aim of this study was to analyse our vaginal hysterectomies performed for prolapsed uterus and non prolapsed uterus with benign disease. For the latter indication, a comparison was made with abdominal hysterectomy. Patients and methods – From february 1986 to december 1998, 1008 vaginal hysterectomies were performed in our department: 219 for prolapsed uterus and 789 for non prolapsed uterus with benign disease. During the same time, 217 abdominal hysterectomies were performed for non prolapsed uterus with benign disease. Results – Intra-operative and post-operative complications had the same rates in the two groups. Owing to the low number of abdominal hysterectomies, we cannot draw a valuable conclusion. The study of the literature shows in this field an advantage for the vaginal hysterectomy; mean time hospitalization was shorter in the vaginal group. Conclusion – Advantages of vaginal hysterectomy are multiple : aesthetic, shorter hospitalization, quicker recovery. The low rate of vaginal hysterectomy on non prolapsed uterus with non malignant disease is linked with the lack in training of surgeons for the vaginal approach. In these cases, a rate of 70 % is a realistic one in a well trained hospital center.

Changes in biological characteristics during the cellular aging of ligament fibroblasts derived from patients with prolapsus uteri

Prolapsus uteri in pelvic support disorders are common in elderly women. The etiology is unclear and more likely to be multifactorial. We examined changes in biological characteristics and responsiveness to growth factors during the in vitro cellular aging of cardinal ligamental fibroblasts derived from patients with prolapsus uteri (HPLiF), and compared them with those of cells from age-matched control subjects (HCLiF). HPLiF and HCLiF had almost the same in vitro life span and the age-related patterns of biological parameters were essentially the same. However, the saturation density was significantly higher in HPLiF than in HCLiF. Furthermore, the high proliferative activity of HPLiF to serum mitogens, especially to platelet-derived growth factor, was retained throughout the in vitro life span. p53 protein levels in HPLiF increased at late passages, but were significantly less than in aged HCLiF. These results indicate that the higher proliferative activity in prolapsus fibroblasts may result from the decreased expression of p53 protein and may lead to a decrease in the synthesis and deposition of extracellular matrix components. These results support the hypothesis that functional alterations in ligament fibroblasts are involved in the mechanism of the development of prolapsus uteri.

Laparoscopic cervicosacropexy (a sling procedure) — An innovative endoscopic conservative surgery for the prolapsed uterus

International Journal of Gynecology & ObstetricsVolume 70, Issue S1 p. A145-A145 Urogynecology Laparoscopic cervicosacropexy (a sling procedure) — An innovative endoscopic conservative surgery for the prolapsed uterus Neeta Warty, Neeta WartySearch for more papers by this authorG. Niyogi, G. NiyogiSearch for more papers by this authorA. Padmawar, A. PadmawarSearch for more papers by this author Neeta Warty, Neeta WartySearch for more papers by this authorG. Niyogi, G. NiyogiSearch for more papers by this authorA. Padmawar, A. PadmawarSearch for more papers by this author First published: 10 December 2003 https://doi.org/10.1016/S0020-7292(00)83502-XAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume70, IssueS12000Pages A145-A145 RelatedInformation

Women, Woodfuel, and Health in Adamtar Village, Nepal

Women, wood energy, and health are interrelated subjects. In rural Nepal, women's much needed household energy requirements are met by woodfuel This paper, based on a field study of 100 women, examines the health effects of woodfuel use on women as primary users, carrying large bulks of woodfuel to their homes and inhaling the smoke emitted while cooking. Increasing deforestation has forced women to carry woodloads over longer distances. Wood shortages have also meant that women settle for an inferior quality of wood, and cooking is done in poorly ventilated kitchens. As a consequence, their vulnera bility to health problems has increased. This study found a relation between exposure to woodsmoke and chronic bronchitis in women. A possible association is also seen between carrying heavy loads of wood over long distances and prolapse of the uterus. The paper also examines forest management policy interventions in relation to women's fuel needs.

Zellpopulationen in der Cervix uteri bei der periovulatorischen Muttermundsöffnung

Die mittzyklische Zervixöffnung ähnelt - wenn auch klinisch wesentlich geringer ausgeprägt - der Muttermundsöffnung am Geburtstermin.

Adenomyosis: diagnosis by hysteroscopic endomyometrial biopsy, correlation of incidence and severity with menorrhagia.

To assess the possibility of diagnosing adenomyosis by hysteroscopic endomyometrial biopsy in patients with menorrhagia and to compare the incidence and depth of penetration in patients who did not have menorrhagia. The study group included 53 patients who had menorrhagia and the control group included patients who were to have hysterectomy for conditions like prolapse uterus. Hysteroscopic endomyometrial biopsy was done in the menorrhagia group. The incidence and depth of penetration of adenomyosis were compared in both the groups using Kruskal Wallis H test. For correlation of severity of menorrhagia with depth of adenomyosis: Student's t-test and ANOVA were used. The incidence of adenomyosis was 60% (18 patients) by endomyometrial biopsy in the menorrhagia group as compared to 33.3% in the control group. The mean depth of invasion of myometrium was 4.103 mm in the menorrhagia group and 2.03 mm in the control group. There is a definite correlation between menorrhagia and adenomyosis both in incidence and depth of penetration.

Vaginaefixatio sacrospinalis vaginalis nach Amreich/Richter

From 1988 through March 1997116 patients were treated by sacrospinal ligament fixation according to Amreich/Richter at the Department of Gynaecology of the University of Halle. The therapeutic indications were prolapse of uterus and subtotal or total vaginal vault prolapse after hysterectomy. In 115 cases the fixation was successful. Recurrent vault prolapse occurred in one woman. We observed the following postoperative complications: urinary tract infection (10.3%), temporary irritation of the sciatic nerve (8.6%), inability to void spontaneously (6%), temporary urinary congestion of the right kidney (4.3%) and postoperative blood loss (4.3%). One female patient decreased 5 days postoperatively after cerebral infarction. Some of the advantages of vaginal sacrospinal vault suspension are an uncomplicated approach, the possibility of combination with additive operations, a high incidence of long-term results and good acceptance by the patient. Sacrospinal vault suspension is an exacting operation with a long learning period.

DECREASE IN P53 PROTEIN IN CULTURED CARDINAL LIGAMENT FIBROBLASTS FROM PATIENTS WITH PROLAPSUS UTERI

The authors examined the growth response of cardinal ligamental fibroblasts derived from patients with prolapsus uteri (HPLiF) and compared it with the response of those from control subjects (HCLiF). The growth rate during the logarithmic growth phase was not different between HPLiF and HCLiF, while the cell density at confluence (saturation density) was significantly higher in HPLiF than in HCLiF. When added alone, platelet-derived growth factor (PDGF), insulin-like growth factor-I (IGF-I), and epidermal growth factor (EGF) produced minimal effects on DNA synthesis in HCLiF. The simultaneous addition of PDGF, IGF-I and EGF synergistically stimulated the DNA synthesis. In contrast, PDGF alone was able to initiate DNA synthesis in HPLiF. The combination of PDGF, IGF-I, and EGF significantly stimulated the DNA synthesis of HPLiF compared with HCLiF. p53 protein and p53 gene transcripts decreased by 50% in HPLiF. The anti-WAF1 antibody reacted intensely with a 21-kDa protein in the homogenates of control fibroblasts, while the immunoreactive band in prolapsus fibroblasts was clearly reduced. These results indicate that the higher proliferative activity at near confluency in prolapsus fibroblasts may result from the decreased expression of p53 protein and p53 mRNA followed by the decrease in p21 protein. Furthermore, the failure of cells to enter quiescence may lead to a decrease in the synthesis and deposition of elastin and thus may contribute to the loss of supportive function in uterine connective tissues.

DECREASE IN ELASTIN GENE EXPRESSION AND PROTEIN SYNTHESIS IN FIBROBLASTS DERIVED FROM CARDINAL LIGAMENTS OF PATIENTS WITH PROLAPSUS UTERI

Abnormal connective tissues may be a key factor in the development of pelvic supportive disorders. Elastin gene transcripts and elastin synthesis in cultured fibroblasts derived from cardinal ligaments of patients with prolapsus uteri and compared them with those in fibroblasts from age-matched control patients were examined. Elastin mRNA steady-state levels and elastin synthesis were significantly down-regulated in quiescent fibroblasts from prolapsus uteri patients compared with quiescent control fibroblasts. Although transforming growth factor β1 (TGF-β1) promoted elastin mRNA and protein levels in fibroblasts from both prolapsus uteri and control patients, the maximum levels of elastin gene transcripts and elastin synthesis in response to exogenous TGF-β1 were significantly lower in prolapsus uteri fibroblasts than control fibro-blasts. These results suggest that the marked reduction in elastin gene transcripts and elastin production in fibroblasts cultured from elderly women with prolapsus uteri could lead to a paucity of ligament elastic fibres and thus may contribute to the loss of supportive function in uterine connective tissues.

A thermal burn to a prolapsed uterus

Burns to the concealed area of the perineum, are relatively rare and usually associated with massive burns and a high mortality rate. A rare case of a thermal burn to a prolapsed uterus is described. The victim was a 72-year-old Bedouin woman, with a 70 per cent total body surface area deep burn from an open fire. In addition to the conventional treatment dictated by such a burn, two unique problems must be considered: (1) the common pathogens of the uterus, Neisseria gonorrhoeae, Chlamydia trachomatis and mycoplasma, are different from those of the skin; (2) the lymphatics of the uterus drain directly into the abdominal cavity and the risk of peritonitis and generalized infection is potentially higher. Intravenous, prophylactic, broad-spectrum antibiotics were therefore initiated immediately following admission. These included: cefoxitin, gentamicin and metronidazole a combination that covers both the potential pathogens of the uterus and the common pathogens of the skin. In addition, and for the same reason, Betadine substituted Flamazine for the local treatment of the exposed uterus. Our patient did not survive the burn, but in a similar, unusual case, the local and systematic remedies must protect against uterine pathogens that are not commonly seen in a burn victim.

Criteria for the diagnosis of diffuse uterine myohypertrophy

Objectives: Diffuse uterine myohypertrophy (DUMH) is a condition clinically diagnosed by the presence of uterine bleeding, homogeneous and diffuse uterine enlargement, and absence of any myoendometrial cause of bleeding. Since the morphologic criteria for the diagnosis of this entity are still controversial, this study aimed to investigate the clinical presentation and the morphologic findings of the cases of DUMH presenting at the University Hospital of Botucatu, São Paulo, Brazil. Methods: We retrospectively studied 43 consecutive patients with DUMH submitted to hysterectomy (test group) and compared the findings with those obtained from 28 patients submitted to hysterectomy due to a prolapsed uterus (control group). There were no significant differences in age, weight or height between the two groups. Results: The uterine weight of the DUMH group (mean ± S.D. 157.4 ± 46.4 g) was significantly heavier than that of the control group (99.5 ± 35.4 g) and myometrial thickness was significantly greater in the DUMH group (2.5 ± 0.5 cm) than in the control group (1.9 ± 0.4 cm). No positive correlation was observed between increased uterine weight and parity, but there was a positive correlation between uterine weight and myometrial thickness. On the basis of the present study, we suggest that the diagnosis of DUMH be made clinically and in cases of uterine weight ≥ 120 g and myometrial thickness ≥ 2.0 cm. In addition, 10 cases of each group were analyzed by morphometry to evaluate interstitial fibrosis and myometrial hypertrophy. The data showed that the increase in uterine weight in DUMH is caused by enlargement of individual myometrial fibers rather than accumulation of interstitial collagen. Conclusion: Discriminant analysis to estimate the diagnostic significance of a number of clinical and pathologic variables (age, parity, uterine weight and morphometric parameters) was able to differentiate cases of DUMH from controls in 100% of the patients.

Laparoscopic Ventrofixation: An Alternate Treatment Approach for Uterine Prolapse

ABSTRACT Uterine prolapse is an anatomic problem that occurs usually in elderly women but may occur in women during their fertile years. The traditional treatment approach has been vaginal hysterectomy. There exists a subset of women with uterine prolapse who desire conservation of the uterus or are high operational risks for hysterectomy. We have performed a new procedure for treatment of these women that has benefits intrinsic to laparoscopy. Thirty-four women underwent laparoscopic ventrofixation of the prolapsed uterus. Fifteen women underwent simultaneous correction of cystocele. In all patients, the procedure has been successful. Follow-up has been for 6–36 months. Urinary urgency and dysuria have been minor and transient complaints. All of the women are content and symptom free. These preliminary results indicate that laparoscopic ventrofixation should be considered in this subset of women, since it offers shorter operative time and hospitalization than vaginal hysterectomy without complications. (...

腹腔鏡下レーザー手術

Operative laparoscopy was performed on ninety-eight cases with gynecologic benign disease. Lasere equipments (Nd: YAG, KTP/YAG, Ho: YAG), electrocautery (monopolar, bipolar, Argon beam coagulator) and Harmonic scalpel were used. For the treatment of ovarian cyst, drainage, ethanol fixation, ablation of lining, stripping of lininig (intra orextracorporeal) and adnexectomy were performed on them. For adhesion, lysis, and/or TUSL (Transection of Utero Sacral Ligament) were carried out. For myoma, adenomyosis, carcinoma in situ of uterine cervix and descensus uteri with adhesion, LAVH (Laparoscopically Assisted Vaginal Hysterectomy) were carried out.In the group of endometriosis with endometrioma, 69.2% (18 of 26) reported over 50% pain relief and 11.5% (3 of 26) reported no pain from menstrual pain after the surgery. Recurrent endometrioma was found in 42.3% (11 of 26). In the group of endometriosis, 71.4% (15 of 21) reported over 50% pain relief and 23.8% (5 of 21) reported no pain from menstrual pain. In the group of pelvic inflammatory disease and dysmenorrhea, 57.1% (4 of 7) reported over 50% pain relief and 28.6% (2 of 7) reported no pain from menstrual pain. In the group of ovarian cyst, recurrent cyst was found in 5.9% (1 of 17). All patients after the LAVH had no complaints.Their complications during and after the operation were minimal. There was no difference between the Laser group and the other group in the results and complications.

Possible Role of the Pessary in the Etiology of Toxic Shock Syndrome

Medical technology often has unforeseen effects on human health. For example, indwelling urethral catheters promote gram-negative endotoxin shock, and improved absorbency in tampons triggered an epidemic of toxic shock syndrome. The pessary is an ancient gynecologic device used to support or position a displaced or prolapsed uterus. As an invasive device, similar to a vaginal tampon or contraceptive diaphragm, the pessary may have increased a woman's risk of vaginal infections, possibly including toxic shock syndrome, especially during the 19th century when prolapsus uteri was a common diagnosis among young women. Evidence for the involvement of the pessary in the syndrome is drawn from early medical texts that attribute toxic-shock-type symptoms, specifically high or fatal fevers, to absorbent pessaries. Further evidence comes from the culture of Staphylococcus aureus from nonabsorbent pessaries.

Incarcerated uterine prolapse associated with a cul-de-sac abscess

Incarceration is a rare complication of uterine prolapse and is usually associated with bladder calculi. We report a case of uterine incarceration associated with an abscess in the cul-de-sac.A 64-year-old woman presented with complaints of vaginal prolapse. Pelvic examination on admission revealed an edematous, prolapsed uterus and eversion of the vagina. The bladder was catheterized, and subsequent attempts to reduce the prolapse were unsuccessful. Conservative treatments were initiated including Trendelenburg positioning, estrogen cream, and moist soaks. Failure to reduce the prolapse under general anesthesia necessitated a vaginal hysterectomy and anteroposterior repair. When the cul-de-sac was entered, there was purulent material draining from an abscess behind the uterus. Postoperatively, the patient received antibiotics for 3 days and was sent home on day 4.Irreducible uterine prolapse is a rare condition and may be attributed to a narrowed introitus, bladder calculi, or pelvic abscesses. Historically, conservative management has attempted to alleviate the edema and restore the prolapse, to allow definitive surgery at a later date. We believe that the pelvic abscess in our case exemplifies a danger of delaying surgery. We recommended that when the patient is in stable condition, a hysterectomy and plastic repair be performed promptly.

Incarcerated uterine prolapse associated with a cul-de-sac abscess

Incarceration is a rare complication of uterine prolapse and is usually associated with bladder calculi. We report a case of uterine incarceration associated with an abscess in the cul-de-sac. A 64-year-old woman presented with complaints of vaginal prolapse. Pelvic examination on admission revealed an edematous, prolapsed uterus and eversion of the vagina. The bladder was catheterized, and subsequent attempts to reduce the prolapse were unsuccessful. Conservative treatments were initiated including Trendelenburg positioning, estrogen cream, and moist soaks. Failure to reduce the prolapse under general anesthesia necessitated a vaginal hysterectomy and anteroposterior repair. When the cul-de-sac was entered, there was purulent material draining from an abscess behind the uterus. Postoperatively, the patient received antibiotics for 3 days and was sent home on day 4. Irreducible uterine prolapse is a rare condition and may be attributed to a narrowed introitus, bladder calculi, or pelvic abscesses. Historically, conservative management has attempted to alleviate the edema and restore the prolapse, to allow definitive surgery at a later date. We believe that the pelvic abscess in our case exemplifies a danger of delaying surgery. We recommended that when the patient is in stable condition, a hysterectomy and plastic repair be performed promptly.

Outcome, complications and follow-up in surgically treated squamous cell carcinoma of the vulva 1956–1982

Between 1956 and 1982, 139 patients were surgically treated in the Netherlands Cancer Institute because of a squamous cell carcinoma of the vulva. Eighty-nine of these patients underwent radical vulvectomy and inguinal lymph-node dissection. Five-year survival rates were 91% for stage I, 85% for stage II, 64% for stage III and 33% in stage IV cases. The fact that 5 year survival rates between the group of patients with a more extensive surgical treatment (i.e., inguinal lymph node dissection) and the group of patients only being treated by a vulvar operation were equal, is a remarkable result. Postoperative complication rates were, in conformity with results found elsewhere, high. Only 25% of the patients did not have any early complicaton at all. The most important early complication was found to be wound infection (52%). Late complications were mostly miction problems (24%) and pelvic relaxation, resulting in cystocele, rectocele and/or descensus uteri (26%). Patients who were treated only by a vulvar operation had significantly less late complications ( P = 0.027). The majority of recurrences were observed in the first 2 postoperative years. Patients with a pelvic relapse or with distant metastases could in no case be treated successfully. Inguinal relapses, however, could only be treated with success when primary treatment of the groin had not been given before. Complete remissions were very often accomplished in case of vulvar relapse and second, third, or fourth relapses on the vulva. Ten percent of all the patients still alive 5 years after primary treatment had a relapse as yet, or more likely, a second vulvar carcinoma. A patient that had a vulvar carcinoma once will be at risk of getting another one for more than 5 years. Although 5 year survival rates after treatment for a vulvar carcinoma are fairly good, postoperative complication rates are very high after extensive surgical treatment. Multicentre prospective randomised trials are recommended in order to optimise treatment safely.