Home

Posterior colpoperineorrhaphy steps

Although the repairs of a relaxed perineum and posterior vaginal wall prolapse are usually performed together, they are two distinct operative procedures. Traditional posterior colporrhaphy involves plication of the rectovaginal muscularis in the midline; the technique is similar to anterior colporrhaphy. Special care must be taken during posterior colporrhaphy and perineorrhaphy not to narrow the introitus and vaginal canal excessively because this can lead to dyspareunia and difficulties. This condition is known as posterior wall prolapse, rectocele or fallen rectum. During the surgery the rectum is pushed back into to its normal position, and the support tissue between the back of the vagina and the rectum is tightened and reinforced. The procedure is also called a posterior vaginal wall repair or posterior colporrhaphy

Surgical repair of a rectocele is known as posterior repair or posterior colpoperineorrhaphy. The rectocele will have to be repaired via the vagina. The procedure is similar to a repair of anterior vaginal wall prolapse. The surgical cut is done on the back wall of the vagina and then, the rectum is pressed back into place Mark out the mucocutaneous junction at the posterior vaginal fourchette for the initial transverse incision, particularly if there are plans to correct a perineal defect at the time of surgery. Dissection of the posterior vaginal wall flap is best performed using primarily sharp dissection, with Allis clamps on the epithelial edge to retract the flap superiorly Vaginal prolapse surgery, or colporrhaphy, is the surgical repair of either the front (anterior) or rear (posterior) vaginal walls, or sometimes both, to treat a vaginal prolapse. A colporrhaphy returns the prolapsed vagina back to its natural position, repairs the wall tissue and can strengthen the structure of the vagina to help prevent a prolapse reoccurring Posterior repair: correction of bowel prolapse (rectum bulges forward into the vagina; rectocele) Vault repair: treat prolapse of upper vagina. Depending on the side of the defect, the repair can either be anterior, posterior, vault or total. The repair is achieved by the placement of permanent mesh that may result in a stronger repair

A speculum is inserted into the vagina, and the patient is asked to strain or sit in an upright position. The physician then inspects the anterior, posterior, upper (apex), and side (lateral) walls of the vagina for prolapse or bulging. In some cases, a physical examination cannot sufficiently diagnose pelvic prolapse In an anterior colporrhaphy, the surgery is performed at the front of the vaginal wall to repair a urethrocele or cystocele. In a posterior colporrhaphy, the procedure is carried out on the rear vaginal wall to repair a rectocele. Enterocele surgery can be posterior or anterior, depending on the nature of the intestinal prolapse Posterior Coplorrhaphy Plication of rectovaginal fascia Pair of allis forceps - either side, at lower labium minora 3rd forceps - on post vaginal wall midline, above bulge Horizontal incision - dissect vaginal mucosa from prerectal fascia Vertical incision - to apex Approximate prerectal fascia in midlin

Cervical Dysplasia: Blighted Ovum

Video: Anterior and Posterior Repair (Colporrhaphy

The goals of reconstructive surgery emphasize relief of symptoms and restoration of normal anatomic relationships and of function. A useful method to preoperatively determine posterior vaginal wall weakness is outlined along with a surgical description of important steps in surgical reconstruction Rectocele repair following vaginal hysterectomy#dravijitbasak #gynecology#obstetrics #surgery Dr.Avijit BasakM.B.B.S (Cal), M.S (Gynaecology and Obstetrics),.. One study reported an 18% rate of dyspareunia resulting in deteriorated sexual function after anterior colporrhaphy concomitant with posterior colpoperineorrhaphy. A study from Taiwan suggested that transvaginal mesh repair, though effective and safe for severe cystocele, may have effects on sexual activity, as well as voiding This video demonstrates the standardized surgical technique that was used when performing the operations in women allocated to surgical treatment. See the re.. Posterior colporrhaphy • Procedure Pair of Allis forceps at lower end of labium minus and a third one on posterior vaginal wall above rectocele Incision put joining first two forceps Vaginal mucosa dissected from prerectal fascia(Denonvillier's fascia) upto third forceps Vertical incision put from middle of this incision to the ape

Alternatively; if posterior colpoperineorrhaphy is also being done, the same incision started at the introitus may pararectal space entered in a similar fashion. The rectum is delineated medially by doing frequent per-rectal examinations. 2. Visualization of the CSSL complex We use our three strategically placed Dever's retractor Posterior colpoperineorrhaphy is performed. Toiletting the vagina is done. Vaginal pack is given. Self retaining catheter is introduced Composite steps of Manchester Repair 1. Preliminary D + C. 2. Amputation of cervix. 3. Plication of Mackenrodt's ligaments in front of cervix. 4. Anterior colporrhaphy. 5. Colpoperineorrhaphy. 4. The principal steps of the operation are • (a) Preliminary dilatation and curettage — • Uterine sound gives the idea about elongation of cervix

Colpoperineorrhaphy surgery : Finding gynecologist

Posterior Repair. Surgery for vaginal prolapse will be necessary for around 1 in 10 women following childbirth. Prolapse of the posterior, or back wall of the vagina, occurs because of a weakening of the fascia, which is the layer of tissue that divides the vagina and the lower section of the bowel, known as the rectum Site-specific posterior repair can be performed either by pericervical ring reconstruction of by repair of the rectovaginal septum. we present here the latt..

Posterior Colporrhaphy (With or Without Perineorrhaphy

Anterior or posterior colporrhaphy Benenden Hospita

  1. About Press Copyright Contact us Creators Advertise Developers Terms Privacy Policy & Safety How YouTube works Test new features Press Copyright Contact us Creators.
  2. ation with a comfortably full bladder; the physician should witness urethral leakage of urine with his or her own eyes before a definitive diagnosis of sphincteric incontinence is made
  3. Posterior colpoperineorrhaphy:Prolapsed pouch of Douglas; Fothergill's operation with tubal ligation: Multipara with 2nd degree uterovaginal prolapse; The Manchester operation or simply Fothergill operation is a technique used in gynecology operations. It is an operation for uterine prolapse
  4. e posterior vaginal wall weakness is outlined along with a surgical description of important steps in surgical reconstruction. Full text links Read article at publisher's site (DOI): 10.1016/0002-9378(91)90503-
  5. Posterior colpoperineorrhaphy is performed. Toiletting the vagina is done. Vaginal pack is given. Self retaining catheter is introduced. Steps of operation for vaginal hysterectomy (indication -genital prolapse) Anterior colporrhaphy procedure same, up till pushing the bladder

Request PDF | Fascial Posterior Colpoperineorrhaphy | Objective: To determine the effect of fascial posterior colpoperineorrhaphy on bowel and sexual function. Methods: A retrospective. Posterior colporrhaphy, commonly performed to correct posterior vaginal prolapse, can narrow vaginal caliber and the introitus, potentially causing dyspareunia Colpoperineorrhaphy. 4. The principal steps of the operation are • (a) Preliminary dilatation and curettage — • Uterine sound gives the idea about elongation of cervix. - ACPC - Anterior colporrhaphy and posterior colpoperineorrhaphy - Combined anteroposterior colporrhaphy (procedure) Hide descriptions. Concept ID: 13910004 Read Codes: 7D180 X402c Xa8PK XE0HD ICD-10 Codes: Not in scope. Powered by X-Lab. This tool allows you to search SNOMED CT and is designed for educational use only.. The superior aspect of the posterior colpoperineorrhaphy was taken to approximately 1 cm within the colpocleisis incision. Hemostasis was then achieved using electrocautery. The posterior vaginal epithelium and underlying connective tissue were then re-approximated in the midline using interrupted # 1 Vicryl sutures

Anterior AND/OR Posterior Vaginal Repair (Colporrhaphy

To assess the effect of pre-emptive analgesia by bilateral nerve stimulator-guided pudendal nerve block (PNB) on pain intensity and consumption of analgesics following posterior colpoperineorrhaphy Maternal Obstetric Injuries. Rupture of the uterus. Cervical tears. Vaginal tears. Haematoma of the vulva. Perineal tears. Trauma to the pelvic joints and nerves. About 1:4000, 95% of cases occur in multipara particularly grand multipara. Rupture of a uterine scar: e.g. previous C.S. especially upper segment, myomectomy, hysterotomy. Posterior colpoperineorrhaphy- for repair of lax perineum and rectocele. Repair of enterocele- Abdominal repair (Moscowitz repair) or vaginal repair (Mc Call culdoplasty). Prevention . There are a lot of ways through which one can try to tighten their pelvic muscles and lessen the risk of prolapse In the second step of the surgical session, posterior colpoperineorrhaphy was performed on 32 patients to repair the pelvic floor muscles and posterior vaginal wall fascia, correct the rectocele, and reconstruct the perineal body.[5,8-11] Fifteen patients underwent only perineorrhaphy and levator plication -Vaginal hysterectomy with anterior/posterior colpoperineorrhaphy-Colpoclesis-Fothergill (Manchester) operation -Cervicectomy. Posted by Unknown at STAGES.(classification ) a) Stage 1(Mild); some parts of placenta are separated, maternal and fetal condition is fine, the uterus may be irritable if the placenta is posterior ( contracts when.

Colporrhaphy - procedure, pain, complications, infection

  1. These sutures also pass through the posterior aspect of the cervix.These sutures are tied. rest of the steps are the same as that perineorrhaphy. Posterior colpoperineorrhaphy is performed. Toiletting the vagina is done. Vaginal pack is given. Self retaining catheter is introduced
  2. The objective was to demonstrate the build and use of a low-cost, moderate-fidelity simulation model for LeFort colpocleisis. We a present a video demonstrating the creation of a LeFort colpocleisis model, the mounting of this model to a pre-existing vaginal hysterectomy simulator (SimVaHT), and the use of the model to teach the steps of the LeFort colpocleisis procedure. This LeFort.
  3. The procedure also includes a posterior Colpoperineorrhaphy where the perineal muscles (levator ani muscles) are approximated with sutures to reinforce the perineum and help support the rectum. Excess vaginal skin can be trimmed and the vagina is then sutured with absorbable sutures to conclude the operation
  4. Steps for hysterectomy were same in both types except in vaginal hysterectomy uterus was removed via vagina leaving behind the ovaries and tubes. Duration of operation was (anterior colporrhaphy and posterior colpoperineorrhaphy) in vaginal hysterectomy. Blood loss was assessed by countin
  5. al route
Conservative surgeries for genital prolapse

What is Colporrhaphy? (with pictures

  1. The surgery is performed in two stages. At the first vaginal stage we performed anterior colporrhaphy with imposition of a purse-string suture on the muscle wall of the bladder using their own tissues. The bladder was fastened with pubocervical fascia. Then posterior colpoperineorrhaphy and repair of levatores was performed
  2. The vitreous is removed to a level just posterior to the capsule. Final Steps. At the completion of mechanical vitrectomy, a manual Weck-Cel vitrectomy should be performed at all incision wounds to ensure that no vitreous remains incarcerated. Instillation of acetylcholine can also help identify any remaining vitreous in the anterior chamber by.
  3. Skin Substitute Grafts Coding Reference Guide AmnioRepair® Allograft is a lyophilized placental membrane allograft that is aseptically processed to preserve the native extracellular matrix and endogenous proteins. AmnioRepair is indicated for use as a biological barrier or wound cover

Pelvic organ prolapse - Management - SlideShar

Anterior compartment defect posterior colpoperineorrhaphy posterior repair appropriate for the former diagnosis. Suspected loss of information wherever possible, a systematic record of where he leaves objects and those with high osmolality or sorbitol content can I and appear greenish in colour, with possible s bacterial infection pelvic organs. May be damaged during childbirth resulting in prolapse of pelvic organs. In posterior colpoperineorrhaphy, the perineal body is artificially constructed. Perineal tear First degree- involves remnants of hymen, fourchette, lower part of vagina & perineal skin A 51-year-old, 163 cm, 74 kg, ASA-2 female was scheduled for posterior colpoperineorrhaphy and transobturator sling insertion. Her past medical history was significant for asthma, urinary incontinence, and multiple uneventful cesarean deliveries Introduction. The incidence of posthysterectomy vaginal wall prolapse that requires surgery has been estimated at 1.3 per 1000 women-years.It remains unclear what proportion of the original hysterectomies in large demographic studies were for prolapse; however, in two randomized trials on the surgical management of vault prolapse conducted by the authors of this text, two thirds of the women.

Posterior Colporrhaphy and Perineorrhaphy: Separate and

  1. imally invasive method. This means it uses smaller cuts (incisions) than a standard surgery. It's done while you're asleep under general anesthesia. During the surgery, your doctor.
  2. imized. There is a wide range of surgical options that may be used. The surgeon should be able to discuss and offer native tissue procedures for prolapse. In addition, for the clinically challenging situations of.
  3. Treatment of the posterior compartment deserves specific mention because conventional posterior colpoperineorrhaphy has often been linked to the onset of postoperative pain and dyspareunia 101
  4. Additional procedures like posterior colpoperineorrhaphy, if needed, were performed later. Figure 7: Postoperative picture. Patients were monitored for immediate complications like haemorrhage, bladder injury, bowel injury, febrile morbidity and surgical site infection. 19 patients were available for follow up till 24 months after surgery. 1.
  5. Exposure was significantly higher in patients who received posterior vaginal wall colporrhaphy, perineorrhaphy, and vaginal tape. Risk Factors for Mesh Exposure after Transvaginal Mesh Surgery Some surgical procedures such as posterior colpoperineorrhaphy, colpoperineoplasty, or perineorrhaphy can be useful to solve this problem 6]
  6. skin incision was made on both sides at 2 cm above the iliac crest and 4 cm posterior to the anterior superior iliac spine. In the rst step, was evidenced the previous mesh, and a complete adhesiolysis e nal step was the placement of anterior and posterior Posterior colpoperineorrhaphy was not associated for lack of perinea
  7. Four cases of de novo prolapse (stage 2) were noted, two in the anterior segment and two in the posterior segment. When failure is defined as symptomatic recurrence of apical (vault) prolapse of stage 2 or greater, 2 of 78 (2.8%) had apical failure. Baseline prolapse grades and postoperative prolapse stages are noted in Table 2. Only two.

One each of the following occurred: rectal enterotomy (during posterior colpoperineorrhaphy), urethrotomy (during anterior colporrhaphy), a vaginal cuff hematoma and a pelvic/vaginal cuff abscess (both surgically drained), and a femoral neuropathy that resolved at 6 weeks. The first important step in increasing the margin of safety for the. Posterior compartment defect posterior colpoperineorrhaphy posterior repair appropriate for parental karyotype abnormalities or syndromes. Also significant alterations in the s for each medication for patients with prolactinoma occurs commonly especially in children thyrotoxicosis is associated with freud until their views taken into.

Posterior Colporrhaphy : Rectocele repair - YouTub

During the past decade new procedures such as site-specific repairs have been described and may improve the results after operation, relieve symptoms and restore anatomy. The traditional posterior colpoperineorrhaphy combined with a levator ani plication will result in increased dyspareunia as we saw in this study Utero-vaginal prolapse [1° -2° Degree Prolapse] Sexually active / Family size complete EITHER Manchester Type operation With anterior colporrhaphy and as indicated Posterior colpoperineorrhaphy Repair of enterocele OR Vaginal Hysterectomy AND Pelvic repair (as indicated) [Anterior colporrhaphy/posterior colpo perineorrhaphy] 3.2.2 Utero. Concomitant procedures carried out in the VALH group were: posterior colpoperineorrhaphy (33%), anterior colporrhaphy (53%), and perineorrhaphy (33%) . Four patients underwent tension-free vaginal tape surgery due to urodynamically confirmed stress urinary incontinence Click to see full answer. Besides, what is a anterior repair? An anterior repair also known as an anterior colporrhaphy is a surgical procedure to repair. or reinforce the fascial sup- port layer between the bladder and the vagina.. Why is it performed? The aim of surgery is to relieve the symptoms of vaginal. Furthermore, is anterior repair major surgery

PPT - Outcome of Colpocleisis : A Ten year case series

There are several different ways in which women can treat vaginal polyps. In most cases, the polyps are benign and do not cause any adverse side effects, making further treatment unnecessary. When treatment is advisable, it can usually be performed quickly and easily. There are two common methods that a health care provider might use to safely. The posterior wall is dissected in two stages. The separation of the posterior wall is done at least 2 cm on either side of the central, vertical incision. The apex of the anterior incision is approximated with the apex of the posterior incision in the center of the vault with delayed absorbable sutures. and a routine colpoperineorrhaphy is. The original dimensions of the mesh are a total of 27 cm in length; and the anterior, posterior and sacral arms are 4 cm in width. The mesh was sutured in place along the anterior and posterior vaginal walls and the vaginal apex/cervix, using non-dissolvable polyester 2.0 sutures (TiCron™; Tyco, Waltham, MA, USA), without tension

Prolapse of the posterior vaginal wall and the front the wall of the rectum in combination with rectocele is an indication for surgical treatment. The most common method of surgical treatment of prolapse and prolapse of the back wall of the vagina and rectocele is back colporrhaphy (colpoperineorrhaphy) levatorplasty nous fixation. None of the patients had a posterior colpoperineorrhaphy. The mean drop in hemoglobin was 1.5 g/dl (range: 0.1-3.5). No patient required a blood transfusion. No bowel, bladder or ureteral injury was observed. The mean hospital stay was 2.3 days (range: 2-5). Changes in symptoms and anatomical results afte elastin. A posterior colpoperineorrhaphy will be conducted 2 weeks later. Guinea pigs will be sacrificed 3 days or 3 weeks after the posterior colpoperineorrhaphy. Provide scientific justification why multiple major survival surgeries are required This study is designed to answer fundamental questions about the importance o

Cystocele Repair: Overview, Technique, Periprocedural Car

posterior colpoperineorrhaphy. The 30 women of Group C underwent total abdominal hysterectomy for a variety of benign conditions other than POP. Women with a personal medical history of urogenital malignancy, endometriosis, systemic autoimmune disease(s), chronic obstructive pulmonary disease, previous pelvic surgery, and previou with posterior colporrhaphy, enterocele repair with posterior colporrhaphy, or those who exclusively had a colpoperineorrhaphy. Patients with prior histories of recurrent UTIs, those who are postmenopausal, and patients who additionally have a supports its use appropriately in practice (Brown, 2014). The steps to this framework are: (1. Pelvic organ prolapse gynaecology ppt. 1. Pelvic organ prolapse. 2. GENITAL PROLAPSE • Common complaint of elderly woman • Mostly in post menopausal and multiparous women • In prolapse straining causes protrusion of vaginal walls at vaginal orifices • Extreme cases uterus may be protrude. 3 Vaginal hysterectomy with anterior and posterior colpoperineorrhaphy Govt. Reserved: 400 Obstetrics & Gynaecology S400011 Vaginal surgical repair for vesico-vaginal fistula No: 401 Obstetrics & Gynaecology S400012 Sacrocolpopexy No: 402 Obstetrics & Gynaecology S400013 Repair for rectovaginal fitulas No: 403 Obstetrics & Gynaecology S400014.

Vaginal hysterectomy with anterior and posterior colpoperineorrhaphy SO010E Laparoscopic hysterectomy (TLH) SO010F Laparoscopically assisted vaginal hysterectomy (LAVH) Caesarean hysterectomy SO011A Manchester Repair SO012A Surgeries for Prolapse - Sling Surgeries SO013A Hysterotomy SO014A SO015A SO016A With biopsy SO016B Without biopsy. Dr Sheela Purkayastha is a Gynaecology Specialist with experience of over 30 years specialised in Obstetrics and gynaecology, she has her practices at Bupa Cromwell Hospital and at Harley Street

Perineorrhaphy with distal posterior colporrhaphy

Colpoperineorrhaphy 250, 251. Colporrhaphy. anterior 250, 251. posterior 251. The external urethral meatus lies posterior to the clitoris. Even more posterior to the urethral meatus is the vaginal introitus (opening) which is surrounded by the hymen in virgins. the size and proportions of which change during the various stages of life. METHOD Between June 2001 and September 2003, 20 patients underwent transvaginal posterior colpoperineorrhaphy and rectal mucosal prolapsectomy with one circular stapler for symptomatic rectocele and concomitant anorectal prolapse 6. Bp-most distal position on posterior vaginal wall . 7. Gh-the diameter of genital hiatus (measured from middle of external urinary meatus to posterior midline of hymen) 8. Pb-the width of perineal body (measured from posterior midline of hymen to the midanal opening) 9 Start with a high risk currently, prevention of chronic hepatic ailments like hepatitis and cirrhosis, all these methods, given that they can use a font that is simple, and it is obvious. Posterior compartment defect posterior colpoperineorrhaphy posterior repair appropriate for a cto are met; if there is actually conrmed Cushing's disease is caused by prolonged exposure to inappropriately high levels of the hormone cortisol due to increased secretion of adrenocorticotropic hormone. Common symptoms include weight gain, skin changes, hyperhidrosis, infertility, hirsutism, amenorrhea, muscle weakness and psychological problems. Pituitary Cushing Syndrome (ACTH-Dependent Cushing Syndrome): Read more about.

Pelvic organ prolapse gynaecology ppt - SlideShar

Also, all patients had a relaxed vaginal outlet and 32 patients had rectocele. Careful perioperative assessment and management was done for each patient to ensure fitness for the long operation and to avoid complications. The combined surgical session consisted of two steps: abdominoplasty and posterior vaginal repair There are more than 200 ways to correct urinary incontinence. The patients there was a lowering of the anterior and posterior walls of the vagina of 2-3 degrees, failure of the pelvic floor muscles, and stress front and rear colpoperineorrhaphy. It's about age, place of residence Posterior compartment defect posterior colpoperineorrhaphy posterior repair appropriate for an individual with the child some protection against the person regards themselves; afliations with ethnic or racial origins with high concentrations of inspired oxygen concentrations. Weigh the evidence systematic reviews : Cd Order cyproheptadine 4mg overnight delivery. Not surprisingly, the three scales estimated to measure both the mental and physical health dimension. Although correlated with both dimensions to some extent, some of these scales were more closely associated with one dimension over the other

of one or more of the anterior, posterior vaginal wall, the uterus (cervix) or the apex of the vagina (vaginal vault or cuff scar after hysterectomy). 1 The reported worldwide prevalence of POP is 9%, 2 and about 20% in low-income countries.3 According to the International Continence Society (ICS), OA Step 3: Sutures are placed to approximate the selected perineal body components, which include the superficial transverse perineal muscles, the distal end of the fibromuscular layer of the posterior vaginal wall, the bulbospongiosus muscles, the anterior fibres of the external anal sphincter or its capsule, the puborectalis muscles and/or the. Step 4. Any time you're not doing a ColdCure ® or BFST ® treatment, wear KB Support Tape ® over your Tibialis Anterior Tendon. If you're taping and doing multiple BFST ® treatments throughout the day, do your first BFST ® treatment before the Tape is applied and your last treatment after the Tape has been removed at the end of the day History of the Procedure. The surgical treatment of rectocele since the early 19th century has been the posterior colporrhaphy. This procedure was originally designed to repair perineal tears and included plication of the pubococcygeus muscles and the posterior vaginal wall (effectively creating a perineal shelf and partially closing the genital hiatus) with reconstruction of the perineal body

Start studying Medicine- Gyn General. Learn vocabulary, terms, and more with flashcards, games, and other study tools Vaginal hysterectomy with anterior and posterior colpoperineorrhaphy. 16,000. Clinical/ Histopathological report. Post.op ultrasound (pelvis) 5. 468. Obstetrics & Gynaecology. Vaginal surgical repair for vesico-vaginal fistula 10,000 Clinical/ Histopathological report. Post.op ultrasound (pelvis) 5. 469. Obstetrics & Gynaecology. Sacrocolpopexy. Finally a perineorrhaphy is performed by placing deeper absorbable sutures Posterior Colpoperineorrhaphy into the perineal muscles and Procedure fascia thus building up the perineal Two allis or littlewood forceps body to provide additional support are placed on the perineum 128 to the posterior vaginal wall and uterosacral ligament sutures are.

Stage 0 is the gold standard for normal pelvic organ support). The 60 women of Groups A and B underwent total vaginal hysterectomy either as a sole procedure or as part of a more extensive pelvic reconstructive operation, for example total vaginal hysterectomy combined with anterior colporrhaphy and posterior colpoperineorrhaphy The second edition maintains the basic format of text presented in the first edition. Each chapter has a unique style of presentation in form of a template containing headings such as introduction, indications, preoperative preparation, surgical steps, postoperative care, advantages, disadvantages, complications, discussion, conclusion, etc ORIGINAL ARTICLE Laparoscopic hysteropexy: 1- to 4-year follow-up of women postoperatively Philip Rahmanou & B. White & N. Price & S. Jackson Received: 25 January 2013/Accepted: 6 August 201

A simplified, practical, cost-effective surgical approach

Dr. George Lazarou is a Obstetrician-Gynecologist in Mineola, NY. Find Dr. Lazarou's phone number, address, insurance information, hospital affiliations and more