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- W2000576873 abstract "Case notes A healthy 68-year-old woman who had had 3 viable offspring and who had undergone hysterectomy had a 3-year history of mild vaginal prolapse. The condition was not bothersome. Afterbeingdiagnosedwithtemporalarteritis,herrheumatologist began treating her with oral prednisone, 100 mg daily. Within 1monthofcorticosteroidinitiation,sheexperiencedcomplete vaginal-vault eversion. The vaginal wall quickly became ulcerated, and she was unable to ambulate because of terrible pain thatwasrelatedtothemassiveprolapse.Twomonthslater,she was severely debilitated and confined to a scooter. During this time period, she also experienced steroid-induced diabetes mellitus and osteopenia. On examination, total eversion of the vaginal vault was noted.Deepulcerationscoveredapproximately60%ofthevagina and were more prominent along the dependent portions of the prolapse (Figures 1 and 2). The genital hiatus measured 3.9 in (10 cm); the vaginal length measured 4.3 in (11 cm). Placement of a size-8 Gellhorn pessary (3.5) failed. Subsequently, the patient was instructed to coat the vagina with estrogen cream and cover the medication with an occlusive dressing (plastic wrap) each night. Because the ulcerations were not infected, no oral or topical antibiotics were prescribed. Conclusions Support of the pelvic floor is maintained by connective tissue, ligaments, and muscles. 1 These supportive structures (ie, the endopelvicfasciaandcardinal-uterosacralligaments)arecomposed of varying compositions of collagen, elastin, smooth muscle, fibroblasts, and vascular structures. 2 Collagen and elastin help provide both strength and flexibility to the pelvic" @default.
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- W2000576873 date "2012-03-01" @default.
- W2000576873 modified "2023-09-26" @default.
- W2000576873 title "Did drug therapy contribute?" @default.
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- W2000576873 doi "https://doi.org/10.1016/j.ajog.2011.12.034" @default.
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