Early 1900's needs
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Johns Hopkins's gynecologistA doctor who specializes in the care and health of the female reproductive organs. Howard Kelly introduced the first plication, or tucking, operation for women in 1914. This colporrhaphy, surgical repair of the vaginaThe tube that joins the cervix (the lower part of uterus, or womb) to the outside of the body. It also is known as the birth canal. , secured the area of the bladder neck with stitches on either side of the urethra. In 1949, a group of specialists, led by urologistA doctor who is specially trained to treat problems of the male and female urinary system, and the male sex organs. Victor F. Marshall, produced the Marshall-Marchetti-Krantz (MMK) procedure, a retropubic suspension of the bladder neck that used an incision in the lower abdomen. Through the incision, urologists stitched the tissue surrounding the bladder neck to the bone or supporting structures. Both the MMK procedure and J.E. Burch's 1961 minimally invasive variation (urethropexy) yielded easy access to immobilize the junction. Another version is the transvaginal approach to bladder suspension--pioneered in 1959 by A.J. Pereyra and since modified by other urologists, including Thomas Stamey, Shlomo Raz and R.F. Gittes. The transvaginal approach involves elevating the bladder neck with sutures placed in the abdominal or pelvic walls. \n\nThe powerhouse operation to treat incontinence in women is the pubovaginal sling procedure. This durable technique first lifted the bladder neck using hammock-like strips of surgically transplanted muscles or ligaments. Germany's P. Frangenheim and W. Stoeckel, in 1914 and 1917 respectively, modified the fascial sling technique first introduced by countryman R. Goebell in 1910 to bolster the bladder and urethra. Others would add their own twists, using synthetic, autologous or cadaver material to create the sling. Secured to the abdominal wall or pelvic bone, the sling lifts the urethra into a normal position. \n\nBut stress incontinence is not exclusive to females. Dating to early 1900, the approaches to control male incontinence have been legion. In the 1920s, for instance, New York's Oswald S. Lowsley tucked tissue around the male urethra for better constriction. \n\nYet the bigger milestones involved the use of internal and external devices to compress the urethra or sphincter. The forerunners of today's Cunningham and Baumrucker penile clamps were crude devices that emerged circa 1750 that were used outside the penisOne of the external structures of the male reproductive system, along with the scrotum and testicles. to clamp it and constrict the urethra. Nearly two centuries later, in 1947, Minneapolis urologist Frederick E.B. Foley introduced the first artificial sphincter. Patients controlled the sphincter by compressing a pocket device to inflate a pneumatic clamp (positioned around surgically segmented portions of the urethra) and stop leaking urine. \n\nSince the early 1900s, skeletal muscle transpositions have been employed for complicated cases of fecal incontinence to augment or replace the anal sphincter. Multiple techniques have evolved that vary with the type and configuration of muscle used in the reconstruction. Transposition of the gluteus maximus muscle was popular in the early stages of development but was replaced by techniques involving transposition of the gracilis muscle. Within the past 16 years, electrical stimulators have been applied to the transposed muscle flaps to create a dynamic reconstruction improving the efficacy of these neosphincters over their static counterparts. However, the stimulated versions are technically demanding with a high rate of morbidity secondary to complications of the multiple components and variations in technique. The stimulator used in this procedure has been removed from the US market, although it is still available in other countries. Currently in the United States, gracilis transposition is still employed in the absence of an electrical stimulator as an adjunct to the artificial bowel sphincter (Acticon NeosphincterTM, American Medical Systems, Minnetonka, MN) such as in cases of severe muscle loss and congenital atresia. In European countries, the stimulated graciloplasty continues to evolve, leading to expansion of its use in total anorectal reconstruction for anal atresia and after abdominoperineal resection\n\n\n\nBaby and Adult Diapers are within the following:\n\nHistory\n\nButt-flaps, as George of the Jungle termed them, have existed since the beginning of time, of course. At that time, though, leaves were used. Yes, leaves. Apparently, milkweed leaves provided comfort for the infant, so they were used for quite some time. Animal skins were used, as well, especially sealskin and rabbit skins. In ancient times, cloth was not used for infants unless it was in the form of swaddling, which consisted of wrapping the infant limb by limb like a mummy. Believe it or not, this continued until the 1800s.\n\nSoft linen and cotton textiles were a precious commodity in ancient times and were used only to adorn the nobility. Scratchy wools and lesser quality cottons were used to swaddle their young. It wasn’t until the early 20th century that soft materials were used in baby diapers. In the mid-1900s, a lady hit on the idea of combining cloth diapers with shower curtain plastic to provide anti-leak protection for her baby. Also invented in the mid 1900s was the first pre-formed disposable diaper. Throughout the next decades, the idea was refined into the product we know today.\n\n \nChoices\n\nCloth diapers no longer need rubber or plastic pants over the baby’s behind. These have evolved into leak-proof, breathing cloth-covered items a world of difference away from cloth diapers in the beginning. Today’s cloth diapers are thicker, with padding providing the most protection in strategic spots for boys and girls. They are elasticized, so the baby can move without restriction. Baby can wear her diaper with no irritation from plastics or rubber, so she won’t have an allergy to the substances. Today’s cloth diaper is hypo-allergenic, as well, so she won’t have an allergic reaction to the cloth.\n\nThe evolution of disposable diapers is nothing short of miraculous. In the day and age of green living, even diapers have gone green. Constructed of sustainable materials and eco-friendly, these cost more, but to the eco-conscious, they are irreplaceable. Baby will wear her green diapers with no allergic reaction, nor irritation. Mainstream brands of disposable diapers have their own versions of eco-friendly coverings, in addition to diapers for sensitive skin. Testing different brands on baby will alert her parents to what she can tolerate and what will give her a rash.\n\nMythbusters\n\nObjections to the use of cloth diapers involve myths such as soaking soiled cloth, stinky storage until they can be washed or rashes on baby’s delicate skin from wearing soiled cloth. Objections to disposable diapers include much the same, but with the added concern of their effect on the environment. The fact is that disposable diapers today are made of materials that break down faster than those back in the day, so landfills are not being overloaded with loaded diapers. Cloth diapers soaking in bleach is no longer done. Detergents friendly to baby’s skin are all around, so washing the diapers immediately gives her fresh diapers with no thought of odor or bacteria from soaking in a diaper pail. In essence, times have changed, so baby’s swaddling is perfectly safe for her little bottom.\n\nThe Inside Out\n\nBaby is going to get a rash at some point in time. It may not have to do with her butt-flap, but with what comes out of her. Certain juices which are too acidic for her little tummy will manifest in a rash, as can a yeast infection. When these happen, a simple anti-fungal cream will help her get back to normal. If, however, the rash comes from wearing her diaper, some things can help her such as:\n\n*Using unscented baby wipes. Perhaps she is allergic to the scented wipes.\n*Switch brands of diaper. Being sure to get unscented, hypo-allergenic diapers.\n*Wash her little bottom with warm water and mild soap instead of using wipes.\n*Thoroughly dry her bottom and use a cream to prevent moisture from affecting her bottom.\n\nFunny Diaper Stories\n\nEven if the arrival of a baby means midnight walks around the house patting her back or emergency calls to grandma to ask what to do when she won’t stop crying, and other such sleep-depriving occasions, it also means funny diaper stories and pictures with which to embarrass her later on in life. Every parent has their favorite naked bum pictures and regales their friends with baby’s diaper stories. And when she grows up to have her own baby, calling on grandma for advice, she will remember those naked bum pictures with amusement as she snaps a few of her own. There is no telling how many babies have snatched off their diapers before they ran down the street waving it in the air. Nor are there statistics detailing how many babies have fallen onto their little bums only to have the diaper come between them and harm. So collect up a few funny diaper stories and stop worrying.\n\nWhether new parents go with plastic or cloth, renewable or disposable baby diapers, all that really matters is what baby’s skin can tolerate. Pay close attention to her and she’ll be glad to tell you what she likes or doesn’t like.