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PubMed1981

Distinctive anthropometric characteristics of women with mitral valve prolapse.

We examined the hypothesis that mitral valve prolapse is often associated with an inherited, anthropometrically distinct habitus. Using standard echo- and phonocardiographic techniques, we identified 60 subjects with mitral valve prolapse, 21 first-degree relatives (12 with mitral valve prolapse and nine normal) and a control group of 57 normal women. Patients with "silent" (echo only) mitral valve prolapse or the Marfan syndrome were excluded. Analysis of measurements taken of the first 39 patients and 46 control subjects revealed that, in relation to their height, patients with mitral valve prolapse had narrower anteroposterior chest diameters and longer arm spans than did the women in the control group. Linear discriminant analysis produced the equation: Z = 17.511 + 98.6 (anteroposterior chest diameter/height)--27.3 (arm span/height). Those with mitral valve prolapse tended to score below zero (mean, --0.62), whereas normal subjects tended to score above zero (mean, --0.39; p less than 0.001). The equation was tested prospectively on 53 subjects, including the 21 family members, and correctly classified 75 percent of all unrelated subjects and 86 percent of the family members as normal or having mitral valve prolapse. Both mitral valve prolapse and discriminant classification followed an autosomally dominant pattern of inheritance. We conclude that a significant proportion of patients with mitral valve prolapse have an autosomally dominant, inherited, anthropometrically distinct habitus, suggesting that mitral valve prolapse is only one component of a generalized developmental syndrome.

Adult↗
PubMed1986

Complications of mitral valve prolapse. Disproportionate occurrence in men and older patients.

To determine factors influencing the strength of association between mitral valve prolapse and mitral regurgitation, ruptured chordae tendineae, and infective endocarditis, the prevalence of mitral prolapse in patients with disease was compared with both clinical and population control groups. The prevalence of mitral valve prolapse was 4 percent among population and clinical control groups (eight of 196 and 84 of 2,146, respectively) and was significantly higher (p less than 0.001) in patients with endocarditis (11 of 67, 16 percent), mitral regurgitation (17 of 31, 55 percent, and ruptured chordae (27 of 43, 63 percent). Odds ratios for complications in persons with mitral valve prolapse ranged from 4.6 for endocarditis to 41.4 for ruptured chordae in overall analyses, and from 6.8 for endocarditis to 53.0 for ruptured chordae based on age- and sex-matched case-control triplets (p less than 0.001 for each). All complications occurred disproportionately in men with mitral valve prolapse, in whom odds ratios ranged from 2.5 to 7.4 compared with an additional control group of unselected subjects with mitral valve prolapse. Compared with this control group, patients with mitral valve prolapse and endocarditis were slightly more likely to have a previously known heart murmur (odds ratio 3.2, difference not significant) but significantly more likely to have murmurs at the time of evaluation (odds ratio 8.5, p less than 0.01). Patients with mitral valve prolapse and mitral regurgitation and ruptured chordae tendineae were also significantly older than the unselected subjects with mitral valve prolapse (48 +/- 14 and 55 +/- 16 versus 38 +/- 14 years, p less than 0.005 for both). The concentration of risk of endocarditis in men with mitral valve prolapse and patients with antecedent murmur suggests that antibiotic prophylaxis is warranted in these groups but not in women without a murmur of mitral regurgitation.

Adolescent↗
PubMed1994

Implications of mitral valve prolapse in children with rheumatic mitral regurgitation.

OBJECTIVES: This study was conducted to determine the longterm prognosis of children with mitral valve prolapse associated with isolated rheumatic mitral regurgitation. BACKGROUND: Rheumatic fever may result in mitral valve prolapse, which sometimes leads to severe mitral regurgitation requiring surgical intervention during the active stage of rheumatic fever. However, the influence of mitral valve prolapse on the prognosis of patients with rheumatic mitral regurgitation remains largely unknown. METHODS: From 1971 to 1991, 181 children who fulfilled the revised Jones criteria of rheumatic fever were identified from a rheumatic fever prevention program. Of the 181 patients, isolated mitral regurgitation was diagnosed in 123 at age 4 to 12 years. The diagnosis of mitral valve prolapse was based on echocardiographic findings. Actuarial event-free curves for persistent murmur, cardiac improvement and surgical intervention were drawn according to the Kaplan-Meier nonparametric estimation. RESULTS: Evidence of mitral valve prolapse was shown in 37 (30%) of the 123 patients. Patients with mitral valve prolapse were more likely to have a larger cardiac size than those without mitral valve prolapse during the active stage of rheumatic fever. Although the cardiac status of patients with mitral valve prolapse may improve under adequate secondary prophylaxis, an actuarial analysis indicated that patients with mitral valve prolapse had a greater likelihood of murmur persistence and surgical intervention. This trend toward murmur persistence was observed even when patients with heart failure during the active stage of rheumatic fever were excluded from analysis. CONCLUSIONS: The presence of mitral valve prolapse in children with isolated rheumatic mitral regurgitation may predict a less favorable outcome.

Child↗
PubMed2004

Progression and remission of pelvic organ prolapse: a longitudinal study of menopausal women.

OBJECTIVE: The purpose of this study was to describe the natural history of pelvic organ prolapse after menopause. STUDY DESIGN: Over 2 to 8 years, participants in the estrogen plus progestin trial of the Women's Health Initiative at the University of California Davis had annual pelvic examinations, with an assessment of uterine prolapse, cystocele, and rectocele. The findings from these examinations were used to describe the incidence of pelvic organ prolapse, the probability of progression or regression, and the associated risk factors. RESULTS: At baseline, 31.8% of women had pelvic organ prolapse (n=412 women). The annual incidences of cystocele, rectocele, and uterine prolapse were 9.3, 5.7, and 1.5 cases per 100 women-years, respectively. Incident prolapse was associated with increasing parity and waist circumference. The progression rates for grade 1 pelvic organ prolapse (per 100 women-years) were 9.5 for cystocele, 13.5 for rectocele, and 1.9 for uterine prolapse. The annual rates of regression (per 100 women-years) was 23.5, 22, and 48, respectively. CONCLUSION: Our data suggest that pelvic organ prolapse is not always chronic and progressive as traditionally thought. Spontaneous regression is common, especially for grade 1 prolapse.

Disease Progression↗
PubMed2002

Correction of leaflet prolapse in valve-preserving aortic replacement: pushing the limits?

BACKGROUND: For aortic dilatation with morphologically intact leaflets, valve-preserving aortic replacement has become an accepted treatment modality. Leaflet prolapse, however, may be present, making composite replacement the most frequent choice. Alternatively, valve preservation may be combined with correction of leaflet prolapse. The results of this approach should be comparable with those of valve-preserving aortic surgery in the presence of normal leaflets. METHODS: Between 1995 and 2002, 156 patients were treated by valve-preserving surgery. The aortic valve was bicuspid in 46, and tricuspid in 110 instances. In 88 aortic valves, apparently normal leaflet coaptation (normal, 12 bicuspid and 76 tricuspid), and in 68 instances, prolapse of one or more leaflets, was observed. Root remodeling (n = 133) or aortic replacement with valve reimplantation (n = 23) were performed. Leaflet prolapse was corrected by triangular resection (n = 16) or plicating sutures (n = 59), mostly placed in the central portion of the leaflet. RESULTS: Neither operative mortality nor 5-year survival were influenced by the additional correction of prolapse. Freedom from reoperation at 1 year (normal, 98.8%; prolapse, 96.5%) and 5 years (normal, 97.3%; prolapse, 96.5%) were comparable in both cohorts, as was freedom from aortic regurgitation > or = II at 1 year (normal, 98.8%; prolapse, 94.2%) and 5 years (94.4%). CONCLUSIONS: Surgical correction of leaflet prolapse in combination with proximal aortic replacement is feasible with good results. Midterm results are identical with those known for morphologically normal leaflets. Repair of prolapse allows for preservation of the native valve in most patients with aortic regurgitation and aortic pathology, and thus appears a beneficial addition to valve-preserving surgery.

Adolescent↗
PubMed1997

Pelvic organ prolapse in young women.

OBJECTIVE: To determine differences in the characteristics and type of genital prolapse in young women compared with older women. METHODS: A retrospective analysis was performed, identifying 647 women who underwent surgical repair of various types of genital prolapse for the years 1979-1991. One hundred ninety-one patients met our inclusion criteria, having well-documented genital prolapse to or beyond the hymen. Patients were stratified into two age groups, those over 35 years and those 35 or younger. The patients were compared regarding "complexity" of prolapse (ie, the total number of deficient sites per patient), grade of prolapse, parity and coexistent medical conditions. RESULTS: During the study period, 27 young women (mean age +/- standard deviation [SD] 30.3 +/- 3.4 years) and 164 older women (mean age +/- SD 60.6 +/- 11.9 years) met our criteria. Young women were more likely than older women to have 1) potential predisposing medical conditions (congenital anomalies or neurologic or connective tissue diseases) (22.2% versus 6.7%, P < .05), 2) lower mean parity (2.8 versus 3.4, P < .05), 3) only one site of prolapse (56% versus 23%, P < .01), and 4) lower grade of prolapse (33% versus 87% grade 3 or higher, P < .001). CONCLUSION: Young patients undergoing surgery for genital prolapse were more likely to have lower parity and single-site and lower-grade prolapse. A higher than expected prevalence of congenital anomalies, as well as rheumatologic and neurologic diseases in the younger women is intriguing, but further study is necessary before these conditions can be implicated in the genesis of genital prolapse.

Adult↗
PubMed1994

Urodynamic characteristics of women with complete posthysterectomy vaginal vault prolapse.

OBJECTIVES: To review the symptoms and lower urinary tract function in women with posthysterectomy vaginal vault prolapse. METHODS: A retrospective review was carried out of the urodynamic records of 19 women with posthysterectomy vaginal vault prolapse who had been evaluated in the Bladder Function Laboratory of the Department of Obstetrics and Gynecology at Duke University Medical Center. RESULTS: A full urodynamic evaluation was carried out on 19 women who had had a hysterectomy and who had subsequently experienced complete prolapse of the vaginal vault. Vaginal eversion produced massive distortion of the lower urinary tract and was associated with complex symptoms. Among the cystometric findings in these patients was an early average first desire to void (94 mL) and a reduced average cystometric capacity (370 mL). Symptoms of voiding difficulty were common. During noninstrumented uroflowmetry, the average peak and mean flow rates were reduced in these women (16.5 mL/s and 8.1 mL/s, respectively), suggestive of functional obstruction of the outlet due to the prolapse. Pressure-flow voiding studies showed a reduced peak flow rate (11 mL/s) with an increased detrusor pressure at peak flow (50 cm H2O), also indicative of functional obstruction. All women underwent urethrocystoscopy, and no patient had a urethral stricture or urethral stenosis. Although symptoms of urgency (79%) and urge incontinence (63%) were common, detrusor instability was confirmed by urodynamic studies in only 3 women (16%), suggesting that urge-related symptoms in these women may often be due to anatomic distortion of the lower urinary tract rather than to detrusor overactivity. "Genuine" stress incontinence was documented in only 2 women (11%) during cystometry; however, when these patients were examined with full bladders with their prolapses reduced and returned to a normal anatomic position with a single-bladed speculum, the physical sign of stress incontinence was demonstrated in all 9 women (47%) who had a complaint of stress incontinence. This suggests that massive vaginal prolapse may mask an incompetent continence mechanism, which may then be revealed after surgical repair of the prolapse. CONCLUSIONS: Women with posthysterectomy vaginal vault prolapse present complicated reconstructive problems for the pelvic surgeon. The same pathophysiological process may produce both voiding dysfunction and stress incontinence. These patients should be evaluated carefully before surgical repair is undertaken. Stress incontinence may not be demonstrated in these patients unless they are examined with a full bladder with their prolapse carefully reduced to a normal anatomic position. Women who demonstrate stress incontinence with the vaginal prolapse reduced and the urethra supported normally should be suspected of having "type III" incontinence (demonstrable stress incontinence in the presence of normal urethral support). Women with these findings may require a suburethral sling procedure if they are to remain continent after correction of posthysterectomy vaginal vault eversion.

Adult↗
PubMed1999

Endoscopic endonasal management of prolapsed silicone tubes after dacryocystorhinostomy.

BACKGROUND: Loss or prolapse of silicone tubes at the medial canthus may occur after dacryocystorhinostomy (DCR) surgery. Repositioning of the prolapsed tubes is often difficult and can necessitate early removal of tubes. The goal of this study was to determine the incidence of tube prolapse after DCR, review the methods used to reposition them, and identify the optimum management. DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: A total of 205 adults patients who had DCR with intubation by a specialist lacrimal service in West London over a 3-year period. METHODS: Patients with spontaneous tube loss or prolapse were identified from clinic attendance and case note review. MAIN OUTCOME MEASURES: Incidence and timing of prolapse, techniques used for repositioning and success, whether prolapse recurred, and further intervention necessary. RESULTS: Five (2.5%) had tube loss or prolapse or both, all within the first month after surgery. The tubes were repositioned initially in four patients, but prolapse recurred in two patients necessitating further intervention. Only nasal endoscopy enabled precise tube visualization and endonasal manipulation with eventual tube stability. CONCLUSIONS: Tube prolapse is rare after DCR surgery. The tubes can be pushed back in, but prolapse may recur unless the endonasal aspect is addressed. The position of the tie or knots should be inspected endonasally and the tubes further secured if indicated. Repositioning is best managed with endoscopic assistance, which is a simple office procedure.

Adult↗
PubMed2002

A prospective study to determine the significance of ventricular late potentials in children with mitral valvar prolapse.

We aimed prospectively to determine the incidence of ventricular arrhythmias and ventricular late potentials in children with mitral valvar prolapse, and to assess whether signal-averaged electrocardiography could identify which such children were at high risk of developing ventricular tachycardia. In all, we examined 151 children with mitral valvar prolapse, at an age of 12.2 +/- 3.1 years, and 164 healthy subjects aged 12.3 +/- 3.7 years. All children underwent 24-hour ambulatory Holter monitoring and echocardiography. The children with mitral valvar prolapse were followed prospectively for a mean of 64 months. There was a significantly higher prevalence of ventricular arrhythmias in those with prolapse than in the controls (p < 0.0001). Runs of ventricular tachycardia were observed in 3 children with mitral valvar prolapse compared with one from the control group. Late potentials were more frequently observed in the children with mitral valvar prolapse than in those who were healthy (p < 0.0001), and also in those with prolapse suffering ventricular arrhythmias compared with those without ventricular arrhythmias (p < 0.02). During follow-up, 24 children with prolapsing mitral valves developed non-sustained ventricular tachycardia, giving a frequency of 3.1/100 subject-years. The sensitivity of late potentials was low, at 52%, for the identification of children with mitral valvar prolapse who developed ventricular tachycardia, although the specificity was high at 90%. This gave a positive predictive value of 50%, and a negative predictive value of 91%. We conclude that prolapse of the mitral valve predisposes to the development of ventricular arrhythmias and late potentials in children. An abnormal signal-averaged electrocardiogram is a specific, but not very sensitive, predictor for the development of ventricular tachycardia in such children.

Adolescent↗
PubMed2003

Differential gene expression in pubococcygeus muscle from patients with pelvic organ prolapse.

OBJECTIVE: This study was undertaken to compare differential gene expression in the pubococcygeus muscle in patients with pelvic organ prolapse and controls. STUDY DESIGN: We performed microarray analysis on individual pubococcygeus muscle biopsy specimens from five patients with stage III or IV pelvic organ prolapse and five control subjects without prolapse. This study received full Institutional Review Board approval. Total RNA was extracted, purified, and probed on the Human Genome U95A Array for each individual sample. RNA from patients and controls was not pooled. For microarray analysis, 7 microg of total RNA was used to synthesize complementary DNA that was then biotinylated. Arrays were hybridized for 16 hours in the GeneChip Fluidics Station 400 and were washed and scanned with the Hewlett-Packard GeneArray Scanner. Affymetrix GeneChip 5.0 software was used for scanning and data analysis. RESULTS: Of the 12626 total genes compared, 257 genes were more than 2-fold underexpressed, 20 genes were more than 5-fold underexpressed, and 3 genes were more than 10-fold underexpressed in patients with pelvic organ prolapse compared with control subjects. Myosin-binding protein H was 24.7 times underexpressed in patients with prolapse (normalized signal intensity [NSI]: 0.46 [0.2-0.6]) compared with controls (NSI: 11.4 [0.2-31.3]). Skeletal muscle myosin heavy polypeptide 3 was 17.4 times underexpressed in patients with prolapse (NSI: 0.85 [0.7-0.9]) compared with controls (NSI: 14.8 [1.5-38.3]). Of the 12,626 genes compared, 479 genes were more than 2-fold overexpressed, 18 genes were more than 5-fold overexpressed, and 2 genes were more than 10-fold overexpressed in patients with pelvic organ prolapse compared with controls. Many of these overexpressed genes were related to actin and myosin proteins. Smooth muscle myosin heavy chain was 11.8 times overexpressed in patients (NSI: 5.21 [0.25-22.71]) compared with controls (NSI 0.44 [0.11-0.71]). Myosin light-chain kinase was 5.8 times overexpressed in patients (NSI: 7.9 [0.5-36.1]) compared with controls (NSI: 1.37 [0.38-1.8]). Extracellular matrix proteins were also differentially regulated. Cartilage oligomeric matrix protein precursor was found to be 6.0 times underexpressed, whereas tenascin-C (hexabrachion) was 5.1 times overexpressed in prolapse patients. CONCLUSION: These data suggest that the differences between patients with advanced pelvic organ prolapse and controls may be related to differential gene expression of structural proteins that are related to actin and myosin as well as extracellular matrix proteins in the pubococcygeus muscle. Studies are ongoing to confirm these findings and to further characterize the role of these genes in prolapse.

Actins↗
PubMed2003

Changes in extracellular matrix proteins in the cardinal ligaments of post-menopausal women with or without prolapse: a computerized immunohistomorphometric analysis.

BACKGROUND: The precise mechanism of uterine prolapse is poorly understood. There is evidence to suggest that abnormalities of connective tissue structure or its repair mechanism may predispose women to prolapse. METHODS AND RESULTS: This immunohistochemical study was performed on paraffin-embedded sections of the cardinal ligaments in an attempt to evaluate differences in the expression of extracellular matrix (ECM) proteins: collagen I, collagen III, elastin and tenascin, in the cardinal ligaments of prolapsed compared to non-prolapsed uteri. There appear to be discernable differences in the level of expression of ECM proteins in prolapsed compared to non-prolapsed cardinal ligaments. We found that the ligaments of the prolapsed uteri are characterized by a higher expression of collagen III and tenascin, and lower quantities of elastin. It appears that the use of HRT in post-menopausal women reverses some of the changes observed in cases of prolapse. Collagen I expression is directly related to the age and menopausal status rather than to prolapse. CONCLUSIONS: In contrast to collagen I, our findings clearly indicate that collagen III expression is directly related to the presence of prolapse rather than age or menopausal status and is suppressed with the use of HRT. The pattern of change may fit a picture of healing phase of traumatized tissue as evidenced by the raised tenascin expression. The trauma itself may have been initiated by events such as childbirth, and that the lack of estrogen following the menopause results in decompensation. In spite of ameliorating some of the changes such as suppression of collagen III expression, treatment with estrogen falls short of rectifying the expression of other necessary proteins. If these mechanisms can be elucidated, a supplementary drug therapy may help along with estrogens to rebuild these ligaments.

Adult↗
PubMedDate not supplied

Computed tomography evaluation of pelvic organ prolapse. Techniques and applications.

OBJECTIVES: Pelvic organ prolapse is a common debilitating condition affecting women. Cross-sectional imaging with magnetic resonance imaging (MRI) depicts pelvic floor anatomy as well as organ prolapse and can complement or replace fluoroscopy. Occasionally, patients cannot tolerate MRI, but multiplanar visualization of pelvic floor soft tissue anatomy and organ prolapse is clinically desired. The objective of this study was to determine if computed tomography (CT) is a potential diagnostic technique in these specific situations for demonstrating organ prolapse and the pelvic floor. METHODS: Seven women (mean age: 63.5 years) with clinical pelvic organ prolapse were referred for CT of the pelvis from the gynecologic and surgical clinics from November 1998 to September 2001. The CT technique included the following: insufflation of rectal air, positive oral contrast, supine position with knees flexed, and imaging at rest and straining with a single-detector scan in 5 cases (slice thickness of 3 mm, table speed of 5 mm/s, 2-mm reconstruction interval) and a multidetector scan in 1 case (detector collimation of 1 mm, slice thickness of 1.25 mm, 1-mm reconstruction interval). Axial and 3-dimensional images were interpreted. RESULTS: Computed tomography demonstrated prolapse in 5 of 7 patients. At CT, cystocele was present in 2 of 7 patients, vault or cervical prolapse was present in 4 of 7, enterocele was present in 3 of 7, rectocele was present in 2 of 7, and levator abnormalities were present in 4 of 7. Surgery was performed in 3 of the 5 patients with positive CT findings, and prolapse was confirmed. Surgery was also performed in 1 patient with negative CT findings, and global prolapse was detected. CONCLUSIONS: Demonstration of pelvic organ prolapse and muscular pelvic floor abnormalities is feasible with CT if the patient strains adequately. In patients who cannot tolerate MRI, CT may be useful as an alternative diagnostic tool.

Female↗
PubMed2005

Vaginal thickness, cross-sectional area, and perimeter in women with and those without prolapse.

OBJECTIVE: Use axial magnetic resonance imaging to test the null hypothesis that no difference exists in apparent vaginal thickness between women with and those without prolapse. METHODS: Magnetic resonance imaging studies of 24 patients with prolapse at least 2 cm beyond the introitus were selected from an ongoing study comparing women with prolapse with normal control subjects. The magnetic resonance scans of 24 women with prolapse (cases) and 24 women without prolapse (controls) were selected from those of women of similar age, race, and parity. The magnetic resonance files were imported into an experimental modeling program, and 3-dimensional models of each vagina were created. The minimum transverse plane cross-sectional area, mid-sagittal plane diameter, and transverse plane perimeter of each vaginal model were calculated. RESULTS: Neither the mean age (cases 58.6 years +/- standard deviation [SD] 14.4 versus controls 59.4 years +/- SD 13.2) nor the mean body mass index (cases 24.1 kg/m(2)+/- SD 3.3, controls 25.7 kg/m(2)+/- SD 3.7) differed significantly between groups. Minimum mid-sagittal vaginal diameters did not differ between groups. Patients with prolapse had larger minimum vaginal cross-sectional areas than controls (5.71 cm(2)+/- standard error of the mean [SEM] 0.25 versus 4.76 cm(2)+/- SEM 0.20, respectively; P = .005). The perimeter of the vagina was also larger in the prolapse group (11.10 cm +/- SEM 0.24) compared with controls (9.96 cm +/- SEM 0.22) P = .001. Subgroup analysis of patients with endogenous or exogenous estrogen showed prolapse patients had larger vaginal cross-sectional area (P = .030); in patients without estrogen group differences were not significant (P = .099). CONCLUSION: Vaginal thickness is similar in women with and those without pelvic organ prolapse. The vaginal perimeter and cross-sectional areas are 11% and 20% larger in prolapse patients, respectively. Estrogen status did not affect differences found between groups.

Adult↗
PubMed2006

Roles of sex steroid receptors and cell cycle regulation in pathogenesis of pelvic organ prolapse.

PURPOSE OF REVIEW: The cause of pelvic organ prolapse is multifactorial and many inciting, promoting and decompensating factors play a role in developing pelvic organ prolapse. Various clinical parameters have been studied quite extensively, but estrogen and collagen metabolism and cell proliferation and apoptosis have not been widely evaluated. This review focuses on assessing the roles of estrogen and its receptor, relationship with collagen metabolism and cell proliferation and cell apoptosis in development and progression of pelvic organ prolapse. RECENT FINDINGS: Differential expressions of sex steroid receptors in various suspensory ligaments of prolapsed uteri have been studied. How different subtypes of estrogen receptor play a role in inducing and aggravating pelvic organ prolapse has yet to be defined. The role of estrogen in collagen metabolism and cell proliferation related to development of pelvic organ prolapse is still under study. Studies on the proliferation of fibroblasts in ligaments of pelvic organ prolapse have yielded conflicting results. SUMMARY: There is still a need for additional research on precise roles of sex steroids, their receptors and cell cycle regulatory proteins and cell proliferation in pathogenesis of pelvic organ prolapse. Some of them could be the cause of pelvic organ prolapse and some of them the direct result of tissue trauma in pelvic organ prolapse.

Apoptosis↗
PubMed2006

Epiglottic and base-of-tongue prolapse in children: grading and management.

OBJECTIVES: A distinct entity of airway obstruction from epiglottic and base-of-tongue (EBT) prolapse in the pediatric population is defined. Laryngopharyngeal findings, swallowing dysfunction, and gastroesophageal reflux disease are described in a group of children with EBT prolapse. A new grading system is also presented. STUDY DESIGN: A prospective study was conducted of laryngopharyngeal findings in children with EBT prolapse, a description of a new grading system, and review of the pediatric literature. METHODS: Fourteen children with EBT prolapse were prospectively studied with flexible fiberoptic nasopharyngolaryngoscopy. A new grading system for EBT prolapse was developed. Grade 0 is a normal airway. Grade 1 is prolapse of the epiglottis against the posterior pharyngeal wall but with normal position of the tongue. Grade 2 is prolapse of the epiglottis and base of tongue with only the epiglottic tip visible. Grade 3 is glossoptosis with no portion of the epiglottis visible. The diagnostic modalities and treatments for EBT prolapse are reviewed. RESULTS: Of the 14 children studied, seven (50%) had grade 1, four (29%) had grade 2, and three (21%) had grade 3 EBT prolapse. Swallowing dysfunction (five of 14, 38%) and gastroesophageal reflux disease (13 of 14, 93%) were also prevalent. CONCLUSION: The new grading system was applied successfully to describe the severity and sites of airway obstruction in 14 children with EBT prolapse. Swallowing dysfunction and gastroesophageal reflux disease occur in this population. Although surgical therapies are sometimes effective, lack of consistent success and the risk of aspiration with procedures other than tracheotomy may lead some to conclude that continuous positive airway pressure or tracheotomy are the safest options.

Adolescent↗
PubMed1997

Epidemiology of genital prolapse: observations from the Oxford Family Planning Association Study.

OBJECTIVE: To explore the epidemiology of uterovaginal and post-hysterectomy prolapse. DESIGN: Cohort study. SETTING: Seventeen large family planning clinics in England and Scotland. POPULATION: 17,032 women who attended family planning clinics between 1968 and 1974, aged between 25 and 39 years at study entry. METHODS: Annual follow up by interview, postal or telephone questionnaire until July 1994. Further details on all hospital admissions were obtained from the hospital discharge summaries. All women were flagged at time of recruitment in the NHS central registers. MAIN OUTCOME MEASURE: In-patient admission with diagnosis of prolapse (ICD codes 8th Revision 623.0-623-9). RESULTS: The incidence of hospital admission with prolapse is 2.04 per 1000 person-years of risk. Age, parity, calendar period and weight were significantly associated with risk of an inpatient admission with prolapse after adjustment for principal confounding factors. Significant trends were observed with regard to smoking status and obesity (Quetelet Index) at entry to the study and risk of prolapse. Social class, oral contraceptive use and height were not significantly associated with risk of prolapse. The incidence of prolapse which required surgical correction following hysterectomy was 3.6 per 1000 person-years of risk. The cumulative risk rises from 1% three years after a hysterectomy to 5% 15 years after hysterectomy. The risk of prolapse following hysterectomy is 5.5 times higher (95% CI 3.1-9.7) in women whose initial hysterectomy was for genital prolapse as opposed to other reasons. CONCLUSION: Among the potential risk factors that were investigated, parity shows much the strongest relation to prolapse.

Adult↗
PubMed1976

Idiopathic prolapsed mitral leaflet syndrome. Angiographic-clinical correlations.

Angiographic clinical correlations were made in 59 patients with prolapsed mitral leaflet syndrome. Eight had nonejection systolic clicks (group I), 20 had early, mid or late systolic murmurs with or without a systolic click (group II), and 31 had pansystolic murmurs (group III). Isolated prolapse of posterior leaflet (PL) scallops occurred in 42 and 17 had combined leaflet prolapse. The study demonstrated the following: (I) Group II patients usually had isolated PL prolapse with a predominant biscallop involvement while a high incidence of triple scallop prolapse and combined mitral leaflet prolapse occurred in group III. (II) Severe mitral regurgitation and a greater incidence of atrial fibrillation were seen in patients with triscallop prolapse and combined mitral leaflet prolapse. Mitral regurgitation was milder in patients with single and biscallop prolapse and, when severe, was associated with ruptured chordae. (III) ST-T wave abnormalities in the inferior leads were most frequent in patients with isolated PL prolapse. (IV) Systolic and diastolic asynergy occurred in 41 patients, most frequently in group II but also relatively frequently in group III (19 of 31). Segmental anterior dysfunction with normal ejection fraction was found in 18 patients, of whom 13 had early anterior wall relaxation. (V) Patients without asynergy were slightly older than those with it. More in the former group had severe mitral regurgitation and were clinically disabled from it.

Angiography↗
PubMed1979

Diagnosis and classification of the mitral valve prolapse by the ultrasoundcardiotomography and the evaluation of the M-mode technic.

Eighty cases with mitral valve prolapse excluding the secondary prolapse of the mitral valve caused by known underlying diseases were studied by real-time ultrasoundcardiotomography and M-mode technic. It was thought that observation of the left ventricle with long axis sector scan was useful and sensitive technic to diagnose the mitral valve prolapse. By comparative study of M-mode technic and ultrasoundcardiotomography, echo sources and the mechanism of so called prolapse patterns such as pansystolic bowing, mid-systolic buckling and multilayered echoes were explained. Pansystolic bowing and mid-systolic buckling were considered as the reliable signs for diagnosis of anterior leaflet prolapse, but were not contributory to diagnose posterior leaflet prolapse and ultrasoundcardiotomographic technic was needed to detect the posterior leaflet prolapse. According to the mode of prolapsing findings by ultrasoundcardiotomograms classification of severity of mitral valve prolapse was undertaken and its grade was expressed as AmPn in which A and P designated prolapse of the anterior and posterior leaflet respectively and m and n indicated the grade of severity in number from zero to five.

Adolescent↗