SEARCH · Search PubMed

Results for “Prolapse”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

SourceResearch connectionFrom yearThrough year

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 793 records · Page 44Linked to original sources

PubMed1997

[Rectal prolapse].

Rectal prolapse is the transposition of the entire rectal wall into the rectal lumen, the anal canal or through the anal canal out side. It differs from anal prolapse in thickness, circular plication of the mucosa and, if large, its extent. The cause is not clearly established, but disorders in bowel movement seem to be of importance. Symptoms reach from the feeling of incomplete evacuation to defecation block and irreducible prolapse. The diagnosis of outer prolapse is easy. The inner prolapse [intussusception] can be suspected by anamnesis and in the presence of solitary rectal ulcer. Defecography gives the conclusive examination. Conservative therapy is analogous to hemorrhoids: Fibres and sufficient liquid intake. Operative procedures can be divided in transabdominal and perineal procedures. From the latter Delorme's procedure gives good results with low stress for the patient. Of the transabdominal procedures we favor rectopexy with Ivalon-sponge, preservation of the lateral bands and sigmoid resection. This procedure can easily be done by laparoscopy. Postoperative constipation is observed above all if the lateral bands are dissected and no sigmoid resection is done. Preexistent constipation Improves in about 50% of the cases. Same does incontinence.

Colonic Diseases↗

PubMed2005

Pessary use in advanced pelvic organ prolapse.

The objective of this study was to review our experience with pessary use for advanced pelvic organ prolapse. Charts of patients treated for Stage III and IV prolapse were reviewed. Comparisons were made between patients who tried or refused pessary use. A successful trial of pessary was defined by continued use; a failed trial was defined by a patient's discontinued use. Thirty-two patients tried a pessary; 45 refused. Patients who refused a pessary were younger, had lesser degree of prolapse, and more often had urinary incontinence. Most patients (62.5%) continued pessary use and avoided surgery. Unsuccessful trial of pessary resorting to surgery included four patients (33%) with unwillingness to maintain, three patients (25%) with inability to retain and two patients (17%) with vaginal erosion and/or discharge. Our findings suggest that pessary use is an acceptable first-line option for treatment of advanced pelvic organ prolapse.

Aged↗

PubMed1986

Cross-sectional echocardiography in the evaluation of aortic valve prolapse associated with ventricular septal defect.

Twenty consecutive patients with ventricular septal defect and aortic valve prolapse were evaluated by cross-sectional echocardiography. Angiographic confirmation was available in all and surgical confirmation was found in 17. In 19, the right coronary cusp was involved and appeared to plug the defect in the precordial long- and short-axis cut. The cusp was deformed and appeared to pivot from the crest of the interventricular septum. In all 19 angiography demonstrated prolapse of the right cusp. Noncoronary cusp prolapse was observed in two by cross-sectional echocardiography and in six by angiocardiography. The ventricular septal defect was perimembranous in 14 and doubly committed subarterial in six by echocardiography. Angiographically, the ventricular septal defect was felt to be perimembranous in 15 and doubly committed in five. Aortic regurgitation was detected by Doppler interrogation in seven, all of whom underwent plication of the right coronary cusp. Angiographic evidence of regurgitation was noted in 11, but four were mild and possibly related to catheter position. Five patients had associated muscular right ventricular outflow tract obstruction and three had a subaortic ridge. Combined cross-sectional and pulsed Doppler echocardiography provide a reliable assessment of right coronary cusp prolapse associated with a ventricular septal defect. Noncoronary cusp prolapse appears more difficult to detect. This technique should help optimize the management of patients by providing a means of early detection prior to the development of aortic regurgitation.

Adolescent↗

PubMed1975

Thoracic skeletal abnormalities in idiopathic mitral valve prolapse.

Idiopathic prolapse of the mitral valve is a common disorder, but many cases are clinically subtle. Thoracic skeletal abnormalities, reported recently to accompany the syndrome, may serve as an easily identifiable clinical indicator. The prevalence of these abnormalities was defined in 24 patients with proved prolapse of the mitral valve. The valvular syndrome was defined clinically, by echocardiography and, in seven cases, by left ventricular angiography. The skeletal deformities were defined clinically and radiographically. Pectus excavatum was present in 62 percent of the patients, "straight back" in 17 percent and severe scoliosis in 8 percent. Eighteen of the 24 patients (75 percent) had a definite thoracic skeletal deformity. The association of idiopathic prolapse of the mitral valve with these skeletal deformities may represent a forme fruste of Marfan's syndrome. Patients with "straight back" and pectus excavatum should be examined clinically and perhaps by echocardiography to exclude idiopathic prolapse of the mitral valve; when murmurs are present, a diagnosis of "pseudoheart disease" should not be made before mitral valve prolapse has been excluded.

Adolescent↗

PubMed2000

A new technique for cystocele repair and transvaginal sling: the cadaveric prolapse repair and sling (CAPS).

A new technique using cadaveric fascia lata for the simultaneous repair of a cystocele and placement of a pubovaginal sling by means of a transvaginal approach is described, and our early results are reported. We refer to this as the cadaveric prolapse repair with sling (CaPS). Fifty patients, ages 37 to 90 years, underwent a new technique for simultaneous cystocele repair and transvaginal pubovaginal sling using a single piece of cadaveric fascia. Maximum follow-up was 6 months (range 1 to 6). A 6 x 8 cm segment of cadaveric fascia lata is placed transvaginally to repair the defect through which the bladder herniates into the vagina and to provide sling support at the bladder neck/proximal urethra. The sling is anchored to the pubic bone with transvaginal bone anchors. The remainder of the fascia is then secured to the medial edge of the levator muscles/pubocervical fascia bilaterally and at the vaginal cuff or cervix with absorbable sutures to reduce the cystocele. Patients are being evaluated with preoperative and postoperative stress, emptying, anatomy, protection, instability (SEAPI) scores as well as with grading of the prolapse based on a 3-grade anatomic classification system. Presenting symptoms have included stress urinary incontinence (SUI) in 13 (26%), urge incontinence in 4 (8%), mixed incontinence in 6 (12%), and pelvic prolapse in 20 (40%). These symptoms are not mutually exclusive; some patients presented with a combination of symptoms. The mean SEAPI scores were 5.51 preoperatively and 0.63 postoperatively, representing a significant improvement (P <0.001). Of the 40 patients whose prolapse was quantified, 1 patient (2.5%) had a minimal cystocele, 16 (40.0%) had moderate cystoceles, and 23 (57.5%) had large cystoceles. After the CaPS, 36 (72%) were completely dry, 3 (6%) had persistent SUI, 1 (2%) had de novo urinary incontinence (UI), 3 (6%) had persistent UI, and 1 (2%) had mixed incontinence. No patient had permanent urinary retention. Transvaginal placement of cadaveric fascia for concomitant sling and cystocele repair provides material of excellent strength for the repair without relying on the inherently weak tissues in the patient with pelvic prolapse. Thus far, the early results with CaPS are extremely encouraging. Long-term follow-up is underway to evaluate the efficacy of this procedure.

Adult↗

PubMed1976

Prevalence of clinical mitral-valve prolapse in 1169 young women.

Eleven hundred and sixty-nine young women were prospectively examined for the presence of mitral-valve prolapse as manifested by midsystolic non-ejection click or late systolic murmur (or both). Of the 1169 women 74 (6.3%) had physical findings consistent with mitral-valve prolapse. Sixty-eight of the 74 (92%) had midsystolic non-ejection click, and in 57 the click was accompanied by a late systolic murmur. In six (8%) only a late systolic murmur was heard. Echocardiography on all patients with clinical diagnosis of mitral-valve prolapse showed patterns of prolapse in 60 of 74 (81%). Fourteen (19%) had negative echocardiograms. We conclude that mitral-valve prolapse is clinically present in approximately 6.3% of otherwise healthy young women.

Adolescent↗

PubMed2004

Reliability of diagnosis of soft cervical disc prolapse using Spurling's test.

The purpose of this study was to determine the sensitivity and specificity of the Spurling's test in predicting the diagnosis of a soft lateral cervical disc prolapse. A prospective study was performed involving 50 patients with neck and arm pain; of these, 25 patients were managed surgically (Group 1) and the other 25 patients were managed conservatively (Group 2). A Spurling's test was performed in all patients and scored as positive or negative. In patients in Group 1, the operative findings were recorded as a soft or hard disc prolapse (osteophyte). In Group 2 patients, the MR findings were recorded as positive for a soft disc prolapse or negative (no disc prolapse or osteophyte only). The results of the Spurling's test were compared with the surgical or MR findings, which were considered as the gold standard. Spurling's test had a sensitivity of 92% and specificity of 95% with positive predictive value (PPV) of 96.4% and negative predictive value (NPV) of 90.9% in predicting a diagnosis of a soft lateral cervical disc prolapse. The high positive predictive value of the test can be utilized to improve the yield of positive MR examinations in patients with cervical radiculopathy.

Adult↗

PubMed2003

Localized venous plexi in the spine simulating prolapse of an intervertebral disc: a report of six cases.

STUDY DESIGN: Six cases are reported in which the clinical presentation of a prolapsed intervertebral disc was found to be caused by a localized venous plexus. OBJECTIVES: To emphasize the fact that the clinical presentation of a localized plexus of epidural veins in the lumbar spine can resemble that of an acute disc prolapse. SUMMARY OF BACKGROUND DATA: The finding of enlarged epidural veins during lumbar disc decompression is relatively common, but it is only recently that they have been implicated as the cause of the presenting symptoms. METHODS AND RESULTS: Six individuals presented with severe pain in the lower back accompanied by sciatica, which had begun acutely. Physical examination in most of these patients showed the presence of neurologic signs in the affected leg. The initial clinical assessment was that of an acute prolapse of a lumbar disc. This diagnosis appeared to be borne out by the MRI scans, which demonstrated a "prolapsed disc" at the relevant level of the spine. However, at surgery, the intervertebral disc appeared to be relatively normal, but at the spine was found a large, localized plexus of epidural veins whose configuration matched the MRI image. The symptoms were relieved by decompression of the spine and ablation of the veins. CONCLUSIONS: Any pathologic process in the lumbar spine compressing a nerve root can cause localized pain in the back accompanied by sciatica. Most of these conditions can be differentiated by means of an MRI scan. The MRI image of a localized plexus of epidural veins, however, closely resembles that of a prolapsed intervertebral disc, which may be diagnostically misleading.

Acute Disease↗

PubMed1975

Echocardiographic detection of mitral valve prolapse. Exclusion of false positive diagnosis and determination of inheritance.

An important potential source of error in the echocardiographic diagnosis of mitral valve prolapse has been identified -- namely a systolic hammock-like pattern of the anterior and/or posterior mitral leaflet echoes, similar to that associated with true mitral valve prolapse, produced artifactually when the ultrasonic transducer is angulated inferiorly. Utilizing a modified, more specific technique we characterized the mode of inheritance and familial prevalence of this disorder. Among 74 subjects, composed of 57 first-degree relatives and 17 propositi with mitral valve prolapse, mitral valve prolapse was detected in 27 of 57 (47%) of the first-degree relatives. Fifty-three percent of female and 36% of male progeny of propositi were affected. Furthermore, familial transmission occurred from propositi to both sexes. Results of this study indicate that mitral valve prolapse is transmitted in an autosomal dominant mode with reduced male expressivity and a familial prevalence of 47% and that appropriate echocardiographic techniques must be employed to avoid a high incidence of false positive diagnosis.

Adolescent↗

PubMed1976

The determinants of onset of mitral valve prolapse in the systolic click-late systolic murmur syndrome.

The onset of mitral valve prolapse and its close correlate, the time of systolic click, vary considerably with different physiologic and pharmacologic interventions. In order to explain the mechanism responsible for these alterations, the effects of tilt and amyl nitrite inhalation on left ventricular dynamics and the time of the systolic click were studied by analyzing echocardiograms and simultaneously recorded phonocardiograms in 14 patients with mitral valve prolapse and mid-systolic click. The patients were studied in the supine position, with 40-60 degrees head-up tilt and after amyl nitrite inhalation. Computer analysis of the recordings was used to measure the left ventricular end-diastolic diameter, the click diameter (left ventricular diameter at the time of mid-systolic click), the maximal velocity of circumferential fiber shortening (max VCF), and the time interval between the first heart sound and systolic click (S1-X). With tilt and amyl nitrite, shortening of the S1-X interval b y an average of 44 and 87 msec, respectively, was observed. The click diameter, however, remained virtually constant with both maneuvers. Earlier prolapse after tilt was due to a decrease in the end-diastolic diameter from 5.03 +/- 0.74 to 4.50 +/- 0.68 cm (P less than 0.001) with no change in max VCF. Immediately after amyl nitrite, earlier prolapse was due to an increase of VCF in the preprolapse period, with max VCF increasing from 2.15 +/- 0.27 to 3.06 +/- 0.40 circ/sec (P less than 0.001), there being no change in the end-diastolic diameter up to this time. The constant click diameter indicates that the abnormal valve motion in this syndrome occurs at a critical left ventricular chamber size. Variations in the onset of prolapse are caused by changes in left ventricular end-diastolic dimensions and the velocity of circumferential fiber shortening in the preprolapse period.

Adult↗

PubMed1977

Limitations of the echocardiogram in diagnosing valvular vegetations in patients with mitral valve prolapse.

In order to assess the reliability of the echocardiogram in detecting valvular vegetations in patients with mitral valve prolapse (MVP), echocardiograms from 85 consecutive patients with mitral valve prolapse were reviewed. Eleven patients had thick shaggy echoes confined to the anterior mitral leaflet; eighteen patients had shaggy echoes on the posterior leaflet; and five had abnormal echoes on both the anterior and posterior leaflets. Only one patient had clinical evidence of infective endocarditis. Redundant leaflets which present multiple surfaces for the production of echoes may explain the abnormal echoes that were observed. Patients with echographic features suggesting mild prolapse less commonly exhibited shaggy leaflet echoes than those with more severe prolapse. Because a significant proportion (40%) of patients with MVP had shaggy echoes which closely resembled those seen in valvular vegetations, we feel that the echocardiogram is of limited value in diagnosing infective endocarditis in patients with mitral valve prolapse.

Adolescent↗

PubMed1984

Excision of prolapse of thoracic intervertebral disc. A transthoracic technique.

A new technique for the transthoracic removal of a prolapsed intervertebral disc in the mid or lower thoracic spine is described. Investigations before operation include thoracic myelography, selective spinal angiography and CT scanning. Image intensification is used at operation to check the level of the prolapse. A tunnel in the coronal plane (vertebrotomy) is made through the posterolateral part of the disc and the adjacent vertebral bodies, to reach the spinal canal at the site of the prolapse. This gives good exposure and enables gentle removal of the disc prolapse and any associated osteophytes, under direct vision without need for retraction or pressure on the dura or spinal cord. Spinal stability is not compromised, and the blood supply of the cord is not disturbed. Five consecutive patients are reported, including one in whom the disc prolapse was calcified and had herniated into the spinal cord. All were treated successfully.

Adult↗

PubMed1976

The relationship between prolapsing mitral leaflet syndrome and angina and normal coronary arteriograms.

Patients with a prolapsing mitral leaflet frequently have chest pain while their coronary arteriograms are normal. In this regard, these patients are similar to the group of patients with angina and normal coronary arteriograms. In the present study, clinical, electrocardiographic, cardiac hemodynamic, angiographic, and metabolic findings in 20 patients with a prolapsing mitral leaflet were compared to those of 16 patients with angina and normal coronary arteriograms. Except for the presence of mitral leaflet prolapse and systolic clicks, the findings were similar in both groups. We postulate that prolapsing mitral leaflet is probably related to two different mechanisms. In one the primary pathologic change is in the mitral valve (mainly myxomatous transformation), and the abnormalities of ventricular contraction are secondary to unloading of the heart because of a volume shift into the distended and enlarged mitral leaflets. In the other group, the primary pathologic change is in the myocardium, with secondary prolapse of the mitral valve. The myocardial abnormality itself is probably related to primary underlying myocardial disease or to arteriolar pathologic changes. The latter group has probably the same pathophysiologic abnormality as patients with angina and normal coronary arteriograms.

Adult↗

PubMed1983

Spinal cord compression due to prolapse of cervical intervertebral disc (herniation of nucleus pulposus). Treatment in 26 cases by discectomy without interbody bone graft.

Twenty-six patients who presented with spinal cord compression due to cervical disc prolapse (herniation of the nucleus pulposus) were treated by anterior discectomy. There was a high incidence of disc prolapse at the C3-4 level. The most severe degrees of preoperative disability were associated with prolapse at that level. Impairment of posterior column function, particularly in the upper limbs, played a major part in producing disability. High cervical disc prolapse can produce a clinical picture that is predominantly like that of a posterior cord syndrome. Preexisting fusion of vertebral bodies in the cervical spine and a history of cervical spinal trauma appear to be predisposing factors. Discectomy is an effective treatment of this condition. Spinal cord compression due to cervical disc prolapse should be distinguished from spondylotic myelopathy.

Adult↗

PubMed1976

Arrhythmias in the mitral valve prolapse syndrome. Prevalence, nature, and frequency.

Ambulatory monitoring and maximal treadmill exercise were compared in 40 normal subjects and 31 patients with mitral prolapse. A variable arrhythmia spectrum was observed in prolapse during monitoring: premature ventricular contractions in 18 (58%), supraventricular arrhythmias in 11 (35%), and bradyarrhythmias in 9 (29%). Significantly less arrhythmias occurred in normal subjects during monitoring: 10 (25%, P greater than 0.001), 3 (8%, P less than 0.001), 4 (10%, P less than 0.05), and 2 (5%, P less than 0.02), respectively. In patients with prolapse, arrhythmias occurred on resting electrocardiogram (ECG), 35% premature ventricular contractons, 6% supraventricular arrhythmias, and 10% bradyarrhythmias, and on treadmill exercise, 45%, 10%, and 3%; therefore, ambulatory monitoring was the most sensitive method of arrhythmia detection. No correlation existed between clinical features of prolapse and arrhythmias. Thus, arrhythmias occur in most patients with mitral prolapse, are not predictable by clinical characteristics, comprise a spectrum of ventricular and supraventricular tachyarrhythmias and bradyarrhythmias, and are best detected by ambulatory ECG monitoring.

Adult↗

PubMed1976

[Mitral valve prolapse and the ventricular pre-excitation syndrome (author's transl)].

One of the most important clinical aspects of the mitral valve prolapse syndrome is the high incidence of arrhythmias. Some recent reports on the association of mitral valve prolapse with ventricular pre-excitation may be relevant to the understanding of such arrhythmias. In order to evaluate the clinical relevance of this association, all patients with proven idiopathic mitral valve prolapse who came under our observation during the last twelve months, were submitted to careful electrocardiographic examination with the aim of detecting even subtle degrees of pre-excitation. His bundle recording and programmed atrial stimulation were performed if there was any suspicion of a delta wave. The association with ventricular pre-excitation was proved in 6 out of 41 examined cases. The main clinical, phonocardiographic, echocardiographic, angiographic and electrophysiologic data, as well as the familial study of these cases, are presented. The need for electrophysiologic study in some cases with doubtful electrocardiographic pattern is pointed out. While previous reports only described cases with left-sided accessory pathways, examples of right-sided pathways are presented in our series. The high incidence of mitral valve prolapse, and especially of pre-excitation syndrome and arrhythmias in the familial study, suggests that the association is not an occasional one. The detection of ventricular pre-excitation in cases of mitral valve prolapse complicated by recurrent tachy-arrhythmias may be of practical importance for an appropriate therapeutic approach.

Adult↗

PubMedDate not supplied

[Diagnosis of 3-level lumbar nucleus pulposus prolapse].

Clinical investigations and plain film of the spine are not sufficient for diagnosis of three-level lumbar nucleus pulposus prolapse. Contrast investigations, especially radiculography with television monitoring, are particularly suitable for demonstration of multiple prolapses. In a material of 730 cases two-level prolapse was found in about 12% of cases and three-level prolapse in about 0.5% of cases and this suggests that radiculography should be carried out routinely before each operation for lumbar nucleus pulposus prolapse.

Adult↗

PubMed1989

[Clinical and computed tomographic follow-up of conservatively treated disk prolapse].

Of a total of 238 patients suffering from root compression syndrome, 41 successfully conservatively treated patients were followed up both clinically and via CT. At follow-up time they were all largely free from complaints. 71% showed unchanged prolapse on CT examination. 29% had a moderate or marked regression of disk prolapse. All unchanged cases of prolapse were medial prolapses. The reason for regression of the sequestered disk tissue is discussed controversially and has not been satisfactorily clarified to date. Improvement of findings in unchanged prolapse is mainly explained by the adaptability of the root if there is enough space for shifting.

Adult↗