Background: Pelvic organ prolapse (POP) is a relatively common condition. In Sweden, the overall estimated prevalence of POP in the female population is 31% and the prevalence of symptomatic prolapse is 8–15%. The prevalence of POP increases with age. The lifetime risk of undergoing pelvic floor surgery is estimated to 11%. The aim of this thesis was to investigate outcomes of vaginal hysterectomy for treatment of prolapse; to study outcomes of cystocele repair surgery and patient satisfaction related to different anaesthesia methods; to explore women’s experiences of vaginal prolapse; and to investigate what is known regarding POP prior to surgery and healthcare-seeking behaviour. Methods: In the Swedish National Quality Register for Gynaecological Surgery (Gynop-register), 941 women were identified who underwent vaginal hysterectomy for prolapse from 1997 to 2005 and 1,364 women were identified who underwent cystocele repair surgery from 2006 to 2009. In-depth interviews were performed with 14 women with vaginal prolapse. Interview data were analyzed with a qualitative content analysis. To investigate women’s knowledge about POP and healthcare-seeking behaviour, a questionnaire was developed, validated and distributed to women with planned surgery for POP. Women undergoing hysterectomy or incontinence surgery were used as reference groups. Results: Severe complications after vaginal hysterectomy occurred in 3% of cases. Sexual activity was improved after vaginal hysterectomy, the number of women reported to have intercourse increased by 20% (p = 0.006). Subjective symptoms of urinary incontinence and overactive bladder were resolved in 50% of the women. De novo stress incontinence was reported by 11% of the women. Use of local anaesthesia (LA) in reconstruction of cystocele showed advantage over other forms of anaesthesia. Length of hospital stay, duration of use of postoperative pain-killing drugs, and time to return to daily activity were shorter among women who underwent surgery with LA compared to other forms of anaesthesia. Patient satisfaction was not related to methods of anaesthesia. In an interview study, the process from recognition the symptoms to seeking healthcare was highlighted. Two categories, “obstacles” and “facilitators” to seeking health care, were identified. One of the obstacles was lack of information on POP in the public domain. The main facilitators were feeling sexually unattractive and impaired physical ability due to POP. Some findings from the interview study were further explored in the questionnaire study. One out of five women with vaginal prolapse did not know that the symptoms were related to prolapse before consulting their physician. Over 30% of the women in the incontinence group were embarrassed to talk about incontinence, and they were unaware that it could be treated. The most frequent description of vaginal prolapse was vaginal bulging. Women in the prolapse group had significantly less access to information through brochures and public media than women in the incontinence group (p < 0.001). Conclusion: Short-term follow-up after vaginal hysterectomy showed that sexual activity and urinary symptoms had improved. Cystocele surgery using LA showed no disadvantage compared to surgery using other anaesthesia methods. POP surgery can therefore be performed safely with LA. Information on prolapse should be easily accessible to improve the possibility for women of gaining knowledge and thereby overcoming obstacles to seeking medical advice. Healthcare professionals have a significant role to play in informing women about symptoms and available treatment options.

Thesis (MMed)-- Stellenbosch University, 2013. / ENGLISH ABSTRACT: Aims of the study Urodynamic studies (UDS) have been suggested to be performed as part of the pre-operative work-up of patients undergoing prolapse surgery. Some women with POP have occult stress urinary incontinence (OSUI) and even if subjectively continent, have a higher incidence of developing de novo stress urinary incontinence (SUI). The aim of this study was to describe the outcome of a group of patients who had pre-operative UDS and manual prolapse reduction. Methods This was a retrospective descriptive study including all women who had prolapse surgery during the period January 2006 to December 2011. Patients received routine pre-operative UDS and manual reduction of prolapse, performed at maximum bladder capacity determined by UDS. Patients demonstrating urodynamic SUI or OSUI were offered a concomitant anti-incontinence procedure. Post-operative follow-up data included symptoms of SUI and clinical evidence of SUI. Results The final group consisted of 131 women. The mean age of the patients was 57 years (range 33 to 79) and parity 3.6 (range 0 to 7). The mean body mass index was 32 (range 19 to 53). Twenty-four (18.3%) women had demonstrable SUI on clinical examination at initial presentation in the clinic. At the time of urodynamic studies, forty patients (30.5%) had evidence of SUI determined by either UDS and/ or cough test in the standing position at maximum bladder capacity. Ninety-one women (69.5%) had no evidence of UI on UDS, of which 20(15.3%) demonstrated OSUI (SUI on manual reduction of prolapse at maximal bladder capacity determined by UDS). Of the 40 women with UI on UDS, 36 had 1-step surgery (combination of anti-incontinence procedure and prolapse repair) and 4 had prolapse surgery alone. Of the 20 women with OSUI on UDS, 16 had 1-step (combined) surgery and 4 prolapse surgeries only. Of the 4 who had prolapse surgery alone, 3 complained of post-operative SUI. In the group with no SUI on UDS and manual reduction of POP, 69 of the 71 women had follow-up data. Only 1 had demonstrable SUI on examination. The manual reduction test had a sensitivity of 42.9% and a specificity of 98.5% (95% CI, 92.0-99.9%). The positive predictive value was 75.0% (95% CI, 19.4-99.3%), with a high negative predictive value of 94.4% (95% CI, 86.2-98.8%). Conclusion The numbers in our study are too small to determine sensitivity and positive predictive value of UDS and manual prolapse reduction for the detection of OSUI. However, our data shows promise in identifying POP patients without OSUI, which is a complement of the hypothesis. We recommend that UDS can be performed pre-operatively in women undergoing prolapse surgery, to identify patients with urodynamic stress incontinence. Manual reduction of the prolapse at maximum bladder capacity can then be done to identify a subgroup of patients without OSUI. Future research is needed on the true predictive value of reduction stress testing with larger numbers. / AFRIKAANSE OPSOMMING: Doel van die studie Urodinamiese studies (UDS) word voorgestel as deel van die pre-operatiewe ondersoeke voor prolaps chirurgie gedoen word. Sommige vroue met genitale prolaps het verborge druklek, en selfs as hulle subjektief kontinent is, het hulle ‘n groter insidensie van de novo druklek. Die doel van die studie was om die uitkoms van ‘n groep pasiënte wat pre-operatiewe UDS en manuele prolaps reduksie gehad het, te beskryf. Metodes Die studie was ‘n retrospektiewe beskrywende studie. Al die pasiënte wat prolapse chirurgie in die tydperk Januarie 2006 tot Desember 2011 gehad het, is ingesluit. UDS en manuele prolaps reduksie tydens maksimale blaaskapasiteit, bepaal deur UDS, was deel van die roetine pre-operatiewe ondersoeke. In die gevalle waar urodinamiese druklek of verborge druklek demonstreer is, is die opsie van ‘n meegaande prosedure vir kontinensie tydens prolaps chirurgie aangebied. Post-operatiewe opvolg inligting het simptome van druklek en kliniese bewys van druklek ingesluit. Resultate Die finale groep was 131 vroue reikwydte. Die gemiddelde ouderdom van die pasiënte was 57 jaar (reikwydte 33 - 79) en pariteit 3.6 (reikwydte 0 - 7). Die gemiddelde liggaamsmassa indeks was 32 (reikwydte 19 - 53). Vier-en-twintig (18.3%) vroue het aantoonbare druklek gehad met kliniese ondersoek tydens die eerste kliniek afspraak. Tydens UDS het 40(30.5%) pasiënte druklek getoon tydens UDS en/ of hoestoets in die staande posisie teen maksimale blaaskapasiteit. Een-en-negentig (69.5%) het geen tekens van urinêre inkontinensie tydens UDS demonstreer nie, waarvan 20(15.3%) verborge druklek demonstreer het (druklek met reduksie van prolapse tydens maksimale blaaskapasiteit, bepaal deur UDS). Veertig pasiënte het urodinamiese druklek gehad, waarvan 36 een-stap chirurgie (‘n kombinasie van prolaps herstel en meegaande kontinensie prosedure) en 4 prolaps chirurgie alleenlik gehad het. Uit die 20 vroue met verborge druklek tydens UDS, het 16 een-stap (kombinasie) chirurgie en 4 prolaps chirurgie alleen gehad. Uit die 4 wat prolaps chirurgie alleen gehad het, het 3 post-operatiewe klagtes van druklek gehad. In die groep wat geen inkontinensie tydens UDS en manuele prolaps reduksie gehad het nie, het 69 van die 71 vroue opvolg data gehad. Druklek kon net by een pasiënt met ondersoek demonstreer word. Die manuele reduksie toets het ‘n sensitiwiteit van 42.9% en ‘n spesifisiteit van 98.5% (95% CI, 92.0-99.9%) gehad. Die positiewe voorspellingswaarde was 75.0% (95% CI, 19.4-99.3%), en die negatiewe voorspellingswaarde was 94.4% (95% CI, 86.2-98.8%). Gevolgtrekking Die getalle in ons studie was te min om te bepaal wat die sensitiwiteit en positiewe voorspellingswaarde van UDS and manuele prolaps reduksie is om verborge druklek te demonstreer. Die belowende data om pasiënte te identifiseer met genitale prolaps sonder verborge druklek (‘n kompliment van die hipotese). UDS kan pre-operatief gedoen word in pasiënte wat prolapse herstel chirurgie benodig, om pasiënte met urodinamiese druklek te identifiseer. Manuele reduksie van die prolaps tydens maksimum blaas kapasiteit kan dan volg, om ‘n subgroep van pasiente sonder verborge druklek, uit te ken. Verdere navorsing, met groter getalle word benodig om die werklike voorspellende waarde van die reduksie toets te ondersoek.

Author: Bc. Veronika Valášková Title of the work: The effect of physiotherapeutic procedures on cervical spine surgery. Aim: The aim of my thesis is to give an overview of the physiotherapy treatment after surgery of herniated cervical intervertebral disc. Methods: This thesis is written as a review of literature sources. The thesis consists of three parts, the first of which highlights the issue of kinesiology, biomechanics, stability of the cervical spine, pathophysiology of a prolapsed spinal disc and imaging issues involved in the discovery of a the actual prolapse. The second part deals with the various surgical techniques and associated complications. The final theoretical part looks into physiotherapy treatment after the operation. I examine the chronology of physiotherapy after the operation, and ascertain if there is a necessity to apply a neck brace after the surgery. It is important to answer the question of when it is possible to return to work and when the patient can return to their original physical activities. Results: The results of this thesis shows that postoperative care in individual departments vary and is inadequately described within available resources. Subsequent physiotherapy is dependent on the patient's condition before the operation, the operation itself, and its...

Background: This dissertation is composed of five individual studies of the stapled haemorrhoidopexy operation. The operation was launched to an international audience in 1998 by the Italian surgeon Antonio Longo. In conventional surgery the prolapsed piles are excised from the anodermal part of the prolapse up through the anal canal into the lower rectal mucosa where the pile is divided with diathermy or suture ligated and excised. It leaves open wounds throughout the anal canal. These wounds can be very painful, especially at defecation, and will take from three to six weeks to heal. In the stapled haemorrhoidopexy operation symptomatic haemorrhoids are seen as a disease of anodermal, haemorrhoidal and rectal mucosal prolapse of varying degree. The main component of the prolapse is the redundancy of rectal mucosa. By pushing back the prolapse into the anal canal followed by excision of the mucosal redundancy above the anal canal with a circular stapler devise a mucosal anastomosis is fashioned. This anastomosis is situated immediately above the haemorrhoids and will attach them to the rectal muscular wall to prevent further prolapse. The operation is associated with substantially less pain and a quicker recovery. Methods: For the five studies, a total of 334 patients were operated for haemorrhoidal prolapse. The first operations were performed in February 1998. All patients were assessed preoperatively and postoperatively with the same set of protocols as follows. The symptoms of haemorrhoids were scored with a questionnaire to patients to obtain their independent statements of the frequency of each of five cardinal symptoms: pain, bleeding, pruritus, soiling and prolapse in need of manual reduction. A diary was used by patients to report daily pain scores, use of pain medication and speed of recovery within the first 14 postoperative days. The surgeon rated the deranged anal anatomy before and after surgery. We also developed an algorithm based on the patients’ statement of digital reduction of prolapse (grade 3) and the surgeon’s assessment of lesser prolapse at proctoscopy (grade 2). Absence of prolapse was grade 1. The surgeon also provided statements about the conduct of the operation and rated the technical complexity. The information, for all patients, was entered into an electronic data base. Results: One registry based study and one prospective randomised controlled trial assessed the advantage of performing the operation under perianal local anaesthetic block. The postoperative pain and surgical outcome was independent of the type of anaesthesia. No operation under local block had to be converted to general anaesthesia. Anodermal prolapse is seen in 70 percent of the patients. In a registry-based study we found that excision of the anodermal folds did not increase the postoperative pain provided the excision stopped at the anal verge. In 270 patients with precise preoperative and postoperative classification we found that the symptomatic load was identical for grades 2 and 3. The symptoms were independent of the anodermal prolapse. The symptoms were greatly reduced when the operation turned out grade 1 prolapse. The long-term result was assessed in 153 patients operated 1 year to 6 years previously. The need for early re-intervention was 6.2 percent representing technical error to reduce the prolapse. At the final evaluation 12 patients (8.2 percent) complained of a mucoanal prolapse in need of digital reduction. The mean symptom burden had been reduced from 8.1 to 2.5 points but 17 percent had at least one cardinal symptom with a weekly frequency. Conclusions: Stapled haemorrhoidopexy should be performed as day surgery under local anaesthesia. Any remaining anodermal prolapse should be excised. The optimal long-term outcome is grade 1A or 1B with low symptom score. There was an 87 percent chance of cure of the prolapse with the first haemorrhoidopexy. About half the failures were insufficient primary surgery and half a relapse of the prolapse. / <p>The original title of article IV was "Prolapse grade and symptoms of haemorrhoids are poorly correlated: result of a classification algorithm in 270 patients. The new title after publishing the article is "Grade of prolapse and symptoms of haemorrhoids are poorly correlated: result of a classification algorithm in 270 patients".</p>

Orientadores: Viviane Herrmann Rodrigues, Cássio Luis Zanettini Riccetto / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T08:50:36Z (GMT). No. of bitstreams: 1 Barreiro_TiagoMonteiro_M.pdf: 3202790 bytes, checksum: 218f40f42f2aaad4c7a68ec4fc081044 (MD5) Previous issue date: 2012 / Resumo: Introdução e Objetivos O tratamento cirúrgico dos prolapsos vaginais de compartimento anterior apresenta índices de insucesso significativos. Próteses de polipropileno vêm sendo empregadas visando melhorar a eficácia do tratamento cirúrgico. Apesar dos bons resultados anatômicos, são descritas importantes complicações com o uso das mesmas e novas alternativas têm sido propostas. O objetivo deste estudo foi avaliar a segurança e a eficácia de uma nova técnica cirúrgica para correção de prolapso vaginal anterior. Pacientes e Métodos Foram incluídas no estudo 34 mulheres com prolapso de parede vaginal anterior estágio ? 2 da classificação de Pelvic Organ Prolapse Quantification (POP-Q) associado ao prolapso apical. No pré-operatório foi realizado exame ginecológico e avaliação do prolapso genital. A avaliação subjetiva constou de questionário de qualidade de vida International Consultation on Incontinence Questionnaire - Vaginal Symptoms (ICIQ-VS). Todas foram submetidas à correção cirúrgica com interposição de tela de polipropileno tipo 1, fixado em sua porção apical ao ligamento sacroespinhoso bilateralmente e em sua porção suburetral em região de membrana do músculo obliquo interno através de sistemas de ancoragem tecidual (Calistar A - Promedon). Após seis meses de seguimento, avaliou-se a cura objetiva, considerada estágio ? 1 de POP-Q e a cura subjetiva. Foi utilizado o método de Fisher, Razão das Chances e Wilcoxon para análise estatística. Resultados A média (±DP) dos pontos Aa, Ba e C antes da cirurgia foi de +1,8 (±0,9), +3.41 (± 1.55) e -0.33 (± 3.32). Aos seis meses o ponto Aa e Ba passou para-2.41 ± 0.67 e -2,64(± 0,58) e o ponto C para -7,55 (± 1,82) (p<0,01). O ICIQ-VS no préoperatório foi, para sintomas vaginais, 37,7 (±14,8), para problemas sexuais de 6,0 (±9,1) e a influência na qualidade de vida de 5,7 (±3,0). Seis meses após a cirurgia, foi observada redução significativa sobre sintomas vaginais para 11 (±8,5) (p<0,01) e qualidade de vida 1,0(± 2,0) (p<0,01). O score para problemas sexuais foi 2,1(± 2,5), não atingindo significância estatística (p=0,1675). Não houve sangramento ou necessidade de reintervenção cirúrgica por dor ou infecção. Exposição de tela foi observada em cinco pacientes (14,7%). Quatro (11,7%) pacientes apresentaram retenção urinária. Três (8,8%) das pacientes apresentaram infecção de trato urinário. Conclusões O Calistar A apresentou bons resultados no tratamento cirúrgico do prolapso vaginal de parede anterior e apical com melhora significativa na avaliação subjetiva e objetiva. Os resultados iniciais mostram que a técnica foi segura e eficaz, no seguimento de seis meses / Abstract: Introduction and Objectives Surgical treatment of anterior vaginal prolapse has significant failure rates. Polypropylene prostheses have been employed to improve the effectiveness of surgical treatment. Despite good anatomic results the use of these prostheses are still present complications and new methods are being proposed. This study evaluated the safety and efficacy of a new surgical technique for correction of anterior vaginal prolapse. Patients and Methods The study included 34 women with anterior vaginal wall prolapse stage ? 2 and apical prolapse according to the Pelvic Organ Prolapse Quantification (POP-Q). Before surgery all patients answered a Quality of life questionnaire (International Consultation on Incontinence Questionnaire - Vaginal Symptoms- ICIQ-VS). All patients underwent a single incision surgical repair through a type I polypropylene mesh fixed at the apical part of the sacrospinous ligament bilaterally and in the sub urethral portion in internal oblique muscle membrane (Calistar A - Promedon). Patients were followed for 6 months. Objective cure was considered when POP-Q was diagnosed as stage ? 1. Subjective cure was assessed by Quality of Life Questionnaire (ICIQ-VS). We used Fisher's method, Odds Ratio and Wilcoxon test for statistical analysis. Results The mean (± SD) of Aa, Ba and C points before surgery was, +1,8 (±0,9), +3.41 (± 1.55) and -0.33 (± 3.32). At 6 months point Aa and Ba was -2.41 ± 0.67 Ba and -2.64 (± 0.58) and point C was -7.55 (± 1.82) (p<0,01). ICIQ-VS was 37.7 (± 14.8) for vaginal symptoms, 6.0 (± 9.1) for sexual symptoms and the influence on quality of life 5.7 (± 3.0). Six months after surgery, significant reduction was observed on vaginal symptoms 11(± 8.5) (p<0,01) and quality of life 1.0 (± 2.0) (p<0,01). The score for sexual problems was 2.1(± 2.5) and did not reach statistical significance (p = 0.1675). There was no bleeding or surgical intervention for pain or infection. Mesh exposure was observed in five patients (14.7%). Four (11.7%) patients had urinary retention. Three (8.8%) patients had urinary tract infection. Conclusions The Calistar A showed good results in the surgical treatment of anterior vaginal prolapse and apex with a significant improvement in subjective and objective evaluation. Initial results show that the technique is safe and effective / Mestrado / Fisiopatologia Ginecológica / Mestre em Ciências da Saúde

Submitted by Caroline Falcao (caroline.rfalcao@ufpe.br) on 2017-06-21T18:11:37Z No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) viana luciene galvo.pdf: 2798947 bytes, checksum: 3df6a7838cee38b373c26ee48edc4314 (MD5) / Made available in DSpace on 2017-06-21T18:11:37Z (GMT). No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) viana luciene galvo.pdf: 2798947 bytes, checksum: 3df6a7838cee38b373c26ee48edc4314 (MD5) Previous issue date: 2014-02-25 / A “temática anal” aparece como critica as epistemologias científicas que pressupõem que neutralidade e universalidade são atributos que se estendem tanto àqueles e àquelas que produzem conhecimento quanto àquilo que é produzido. Nessa perspectiva, o cu tem sido utilizado, metaforicamente, em discussões político-epistemológicas que reivindicam a desconstrução da norma heterossexual contribuindo para a produção de saberes implicados pela erotização corporal, como também, para a criação de políticas que privilegiam o prazer anal e criticam a reprodução da divisão “norte-sul”, no âmbito das teorizações queer. No entanto, as metáforas, muitas vezes, parecem produzir certa facticidade do uso sexual anal, relacionado à penetração e à passividade. A encenação do prolapso no pornô, quase exclusivamente realizado por atrizes, nos fez questionar se a pornografia pode ir além do sentido de “pedagogia sexual” e caracterizar-se como um campo de potência imaginativa e, nesse caso, de criação de possibilidades corporais que desafiam verdades anatômicas e fisiológicas. Nos interrogarmos também sobre o fato de que a penetração anal seja comumente o único referente do prazer sexual anal e, consequentemente, a base para que se possa pensar as relações sexuais a partir da binaridade “atividade/passividade”. Assim, elegemos como objetivo primordial analisar as disposições de sexualidade e erotismo acionadas pelo prolapso pornográfico no site prolapseparty.com. O material de pesquisa constituiu-se de textos, elementos gráficos e vídeos apresentados no site Prolapseparty.com que foram problematizados a partir de uma perspectiva pós-estruturalista de inspiração Foucaultiana. Consideramos que as fantasias nesse site podem ser vivenciadas pela criação de elementos que incentivem a imaginação de que os atos sexuais podem ir além da tela do computador e fazer parte do cotidiano. Os usos sexuais do ânus, nesse sentido, não envolvem a penetração ou a inserção anal, mas, a exploração da capacidade de elasticidade e excrescência que levou-nos a argumentar que as imagens engendram “prazeres sexuais de superfície”. Outro elemento importante foi a menção à relação de proximidade entre as atrizes que funciona como forma de denotar que o deleite sexual proporcionado pelo deslocamento do reto se diferencia de um ato de “violência”. Assim, a exibição das técnicas que deslocam e criam genitálias e ânus prolapsados abdicam da naturalidade corporal e, consequentemente, enfatizam que o prazer sexual é fabricado. / The "anal subject" is revealed as the scientific epistemologies criticism which assumes that neutrality and universality are attributes embracing both those who produce knowledge as well as what is produced. In this perspective, the asshole has been used, metaphorically, in political and epistemological debates which clames for deconstruction of the heterossexual standards and contributes to production of knowledges involved by the body erotization, and also to the creation of policies that privileges anal pleasure and criticizes the reproduction of "north-south" division in Queer Theories. However, the metaphors often seems to produce certain facticity of sexual anal uses, often related to penetration and passivity. The enactment of prolapses in pornography, almost exclusively performed by actresses, made us wonder if pornography can go beyond the meaning of "sexual pedagogy" and going to be characterized as a field of imaginative power and creation of bodily possibilities that challenge anatomical and physiological truths. We ask also about the fact that anal penetration is commonly the only referent for sexual anal pleasure and, consequently, the basis to think about the sexual relations from the "activity/passivity" binarity. Thereby, we chose as the primary objective to analyze the sexuality and eroticism provisions which are driven by pornographic prolapse at the website prolapseparty.com. The research material was consisted of texts, graphics and videos on this website contents and were debated from a post-structuralist perspective, inspirated by Foucault's theories. We believe that the fantasies in this website contents may be experienced by the creation of elements that encourage imaginations about sexual acts going beyond the screen of the computer and being part of everyday lifes. The sexual uses of the asshole does not involve the penetration or the anal insertion, but the holding capacity of elasticity and excrescence, wich have led us to argue that those images engender "sexual pleasures of surfaces". Another important element to mention is the close relationship between the actresses as a way to denote that the sexual pleasure provided by the displacement of the rectum is different from an act of "violence". Finally, the exhibition of techniques that moves and creates genitals and prolapsed anus abdicates from the body naturally and consequently emphasizes that sexual pleasure is manufactured.

No description available.

Cardiac arrest has been reported in patients with mitral valve prolapse; however, clinical characteristics and survival information are limited since most of the cases reported include autopsy data. Nine patients (2 male, 7 female) with mitral valve prolapse were identified who had cardiac arrest; ventricular fibrillation was documented in 8 patients; resuscitation was unsuccessful in 2. Eight had a history of palpitations (months to 15 years duration) and ventricular arrhythmias, 3 had a history (5-15 years) of recurrent syncope, and 1 was totally asymptomatic. Cardiac catheterization-angiographic studies in 8 patients demonstrated normal coronary artery anatomy and mitral valve prolapse. All 9 patients had auscultatory and echocardiographic evidence of mitral valve prolapse. Seven survivors (6 still alive) were followed from 3 to 14 years after cardiac arrest. A subset of patients with mitral valve prolapse and cardiac arrest is described in whom past medical history is compatible with cardiac arrhythmias or syncope, and whose long-term prognosis appears better than patients with other causes of cardiac arrest.

Objective: To determine whether echocardiography affects the decisions to use beta blockers or to recommend bacterial endocarditis prophylaxis in patients suspected of having mitral valve prolapse (MVP). Design: Retrospective review of echocardiograms and clinical records. Setting: Military tertiary care hospital. Patients: 127 patients with clinically suspected MVP (105) or incidentally discovered MVP (22). Main results: Beta blockers were used more often in patients with suspected MVP and positive echocardiograms (45%) than in patients with normal echocardiograms (13%, p<0.001). Bacterial endocarditis prophylaxis was recommended more often in patients with suspected MVP and positive echocardiograms (65%) than in patients with normal echocardiograms (11%, p<0.001). Presence or absence of a murmur did not influence the decision to recommend bacterial endocarditis prophylaxis. Patients in whom MVP was incidentally discovered were unlikely to receive either beta blockers or the recommendation for bacterial endocarditis prophylaxis. Conclusions: The results of echocardiography affect the decisions to use beta blockers or to recommend bacterial endocarditis prophylaxis in patients with suspected MVP.

Cardiovascular involvement is commonly reported in various muco- polysaccharidoses. We report a first case of Sanfilippo syndrome type A in a 12-year-old white female who has developed combined progressive mitral valvar regurgitation due to prolapse and aortic regurgitation.