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PubMed1977

Mitral valve prolapse due to coronary artery disease.

Controversy exists concerning the etiologic role of coronary artery disease in the prolapsing mitral valve leaflet syndrome. A 35 year old man with progressive coronary artery disease is described. Auscultation before and after his first myocardial infarction revealed only a fourth heart sound; subsequently left ventricular cineangiography demonstrated normal anatomy and function of the mitral valve, despite extensive wall motion abnormalities. Six months later he experienced another myocardial infarction after which the typical mid-systolic click, late systolic murmur of mitral valve prolapse developed. A second left ventricular cineangiogram at this time revealed mid-systolic mitral valve prolapse and mitral regurgitation. This patient's course indicates that myocardial damage from coronary artery disease can cause mitral valve prolapse in patients with preexisting redundant mitral valve tissue.

Adult↗
PubMed1992

A nested case-control study of uterine prolapse.

A nested case-control study was conducted to detect risk factors for periparturient uterine prolapse. Records from 4173 lactations were collected for 5 years from 17 Holstein dairies in the vicinity of Cornell University. Logistic regression was used to model the risk factors for uterine prolapse. Milk fever, dystocia, sex of the calf, and stillbirth were examined as potential risk factors. There was no confounding or effect modification by season of calving and parity. The incidence rate for uterine prolapse was 0.6%. Dystocia and milk fever increased the risk of uterine prolapse five and three times, respectively.

Journal Article↗
PubMed1976

The significance of mitral valve prolapse in middle-aged and elderly men.

The clinical, roentgenographic, phonocardiographic, ECG, and echocardiographic data were evaluated in 40 consecutive middle-aged and elderly male patients with echocardiographically detectable systolic prolapse of mitral valve leaflets. Prolapse was present during more than half of systole in 31 patients and was holosystolic in six patients. In most instances, both leaflets prolapsed during systole. The closing velocity and excursion of the anterior leaflet were frequently increased particularly in association with evidence of mitral insufficiency. A majority of the patients had cardiac symptomatology. Moreover, roentgenographic and/or ECG evidence of cardiac enlargement or hypertrophy was evident in 45 percent of patients with mitral valve prolapse.

Aged↗
PubMed1976

Variations in size of the bony lumbar canal in patients with prolapse of lumbar intervertebral discs.

Prolapse of the lumbar intervertebral disc is one of the commonly accepted causes of low back pain. Most patients respond well to conservative treatment, but some may not respond at all. Though the reason for this variation is not clearly understood, it is felt that a developmentally narrow spinal canal might have some relation to the persistence of backache and sciatica. The canal was therefore measured at each of the lumbar vertebral level by a method described by Jones and Thomson (1969) in 100 consecutive patients operated upon for prolapsed lumbar intervertebral discs, in 100 normal patients for comparison. This method does not give direct measurements of the bony spinal canal but provides a ratio of the size of the canal to the adjacent vertebral body. We found a trend towards the presence of a narrower than normal lumbar canal in patients with prolapsed lumbar intervertebral discs. It is concluded that in patients with prolapsed lumbar intervertebral discs necessitating operation, the canal tends to be narrower than normal, and such narrowing enhances the effect of any disc protrusion leading to severe symptoms of backache and sciatica.

Adolescent↗
PubMed2001

The association of smoking with vaginal flora, urinary tract infection, pelvic floor prolapse, and post-void residual volumes.

OBJECTIVE: This study examined the association of smoking with changes in vaginal flora, the prevalence of urinary tract infection, genital prolapse, and incomplete bladder emptying. METHODS: The authors conducted a retrospective review of charts for 305 women. In addition to smoking habits, data on age, parity, degree of genital prolapse, vaginal flora, urinary residual, urinary tract infection, and hormone replacement therapy were collected and analyzed. RESULTS: Smoking did not correlate with urinary tract infection, the amount of post-void urine residual volumes, or pessary use. Smoking was significantly associated with the presence of a severe degree of genital prolapse. Smoking independently affected vaginal flora, increasing the odds of developing bacterial vaginosis. CONCLUSION: Smoking was associated with an increased risk of developing bacterial vaginosis and having severe genital prolapse. Smoking was not associated with urinary tract infection or the amount of post-void residual urine.

Journal Article↗
PubMed2006

Spontaneous subconjunctival orbital fat prolapse: presentation of four cases.

BACKGROUND: Subconjunctival orbital fat prolapse is a benign entity characterized by orbital fat herniation through a dehiscence in Tenon's capsule, usually between the superior and lateral recti muscles. It is often associated with ocular trauma or surgery, although spontaneous cases have also been reported with a predilection for obese individuals. PATIENTS AND METHODS: A retrospective study of four subconjunctival orbital-fat prolapse cases with no history of ocular surgery or trauma was performed. A trans-conjunctival surgical approach with Tenon's capsule repair was offered to all subjects. Differential diagnosis is discussed. RESULTS: The diagnosis of subconjunctival orbital fat prolapse was confirmed in all cases by histopathological examination. Functional and aesthetic postoperative results were excellent, with no recurrences during follow-up, for all cases. CONCLUSIONS: Although rare, subconjunctival orbital fat prolapse should be recognized. Surgical management offers excellent results.

Adipose Tissue↗
PubMed1999

Neovascularization of nucleus pulposus. A diagnostic feature of intervertebral disc prolapse.

STUDY DESIGN: Seventy-five surgically excised prolapsed intervertebral discs were histopathologically evaluated. Fifteen prospective normal cadaveric discs were used as control specimens. OBJECTIVE: To compare the morphologic features between the prolapsed and normal discs. SUMMARY OF BACKGROUND DATA: The histologic criteria were edge neovascularization of the fibrocartilage, chondrocyte cloning, fibrillation with fraying, and granular change. METHODS: Sections stained with hematoxylin and eosin, Van Gieson's, and toluidine blue were studied. The presence or absence of edge neovascularization was noted. The other criteria were graded based on a semiquantitative scoring system. RESULTS: Edge neovascularization was observed in 56% of the discs in the test group and in none of the control specimens. Fibrillation with fraying was the most significant finding in the test group (P < 0.001). Although the mean grades were higher in the test group, they did not predict the presence of edge neovascularization. CONCLUSIONS: Edge neovascularization was the most significant finding to confirm disc prolapse. Fibrillation with fraying, was observed more frequently in prolapsed intervertebral discs and the grades of fibrillation with fraying, chondrocyte cloning, and granular change were significantly higher in the test group. Pathologists can usually agree on the presence or absence of a particular histologic characteristic but are rarely consistent when they estimate the degree. Simple, reproducible agreed-on criteria are needed before semiquantitative evaluations become reliable.

Adolescent↗
PubMed2002

Risk factors for preterm delivery in patients demonstrating sonographic evidence of premature dilation of the internal os, prolapse of the membranes in the endocervical canal and shortening of the distal cervical segment by second trimester ultrasound.

OBJECTIVE: To investigate the outcomes and risk factors associated with the second trimester sonographic findings of premature dilation of the internal cervical os, prolapse of the membranes into the endocervical canal and shortening of the distal segment. STUDY DESIGN: Retrospective chart review to identify patients who met the following criteria: (i) gestational age between 16 and 24 weeks; (ii) a vaginal probe ultrasound documenting dilatation of the internal os, prolapsed membranes into the endocervical canal but not extending beyond the external os, and a shortened distal cervix; and (iii) no evidence of increased uterine activity METHODS: Sonographic measurements obtained included: (i) the width of the internal os dilation; (ii) the depth of membranes prolapsed into endocervix (funneling); (iii) the distal cervical length; and (iv) the total cervical length. Patients were stratified into two groups according to gestational age at delivery: the preterm group (< 34 weeks) and the near-term group (> or = 34 weeks). RESULTS: Thirty-seven patients had complete records for analysis and their pregnancies resulted in 47 live births. Eighteen patients were stratified to the near term group and 19 were stratified to the preterm group. There were no stillborn infants and 10 neonatal deaths. Ten patients received cerclage and seven patients delivered at < 34 weeks gestational age. Risk factors found to be significant for preterm delivery included a gestational age at diagnosis of < or = 20 weeks gestation (p = 0.03), dilatation of the internal os > 1.3 cm (p = 0.04), and a composite Benham score > or = 1.0 (p = 0.02). CONCLUSIONS: The sonographic findings of premature dilatation of the internal os, prolapse of the membranes into the endocervical canal and shortening of the distal cervix are associated with a high rate of delivery < 34 weeks (51%) and neonatal death (27%).

Adult↗
PubMed2006

Stapled haemorrhoidopexy in fourth degree haemorrhoidal prolapse: is it worthwhile?

INTRODUCTION: Ten years after the introduction of stapled haemorrhoidopexy few studies have stratified patients by degree of haemorrhoidal disease when analysing results. Objective The aim of this study was prospectively to evaluate 116 patients who underwent stapled anopexy conducted by the same surgeon for III or IV degree haemorrhoidal prolapse. MATERIALS AND METHODS: One hundred and sixteen consecutive patients affected by symptomatic haemorrhoids of III or IV degree underwent stapled anopexy using the technique described by Longo in the period January 2001 to October 2003. Mean follow-up was 28.1 months. Fischer's exact test was used for statistical analysis. Results, in terms of morbidity and recurrence rates, were stratified according to degree of haemorrhoidal disease. RESULTS: There was no statistically significant difference between the results for third degree compared with fourth degree prolapse although there was a trend towards increased incidence of postoperative bleeding and recurrence. CONCLUSION: Third degree haemorrhoidal prolapse remains the best indication for stapled haemorrhoidopexy. This procedure may also be indicated in fourth degree haemorrhoidal prolapse. Patients with fourth degree haemorrhoids may be subjected to this procedure following adequate discussion of the outcome.

Adult↗
PubMed1977

On the frequency of early systolic clicks in mitral valve prolapse.

Phonocardiography was performed in 74 patients with mitral valve prolapse. 24 patients had early systolic clicks (less than 80 msec from S1). Four of them had associated systolic murmurs. 30 patients had mid or late systolic clicks (greater than 80 msec from S1). A systolic murmur followed the click in 13 of these patients. Both an early and mid/late systolic click were noted in three patients. 17 patients did not have systolic murmurs. Seven patients had 'silent' mitral valve prolapse. In summary, early systolic clicks are common in mitral valve prolapse. In many instances the early click is not accompanied by a murmur. Echocardiography is recommended in patients with chest pain or arrhythmia of uncertain etiology, even if characteristic signs of mitral valve prolapse are absent.

Adolescent↗
PubMed1977

Mean velocity of circumferential fiber shortening in prolapsed mitral leaflet syndrome.

In 26 patients with mitral valve prolapse, ventricular function was evaluated by mean velocity of circumferential fiber shortening (MVCF) as measured along the basilar, middle and apical axes. Significantly increased rates of MVCF were found in patients with mitral prolapse along the basilar axis (1.75 +/- 0.23 circ/sec) and middle axis (2.09 +/- 0.34 cir/sec) (P less than 0.025 and P less than 0.05, respectively). Patients with mitral valve prolapse and regurgitation demonstrated a significant increase in MVCF along the basilar axes (1.72 +/- 0.15 cir/sec) (P less than 0.05). Asynergy apperars to have a negative effect on the MVCF along the middle axis. The MVCF was found not to be related to clinical findings, symptoms or electrocardiographic changes. The mechanism for the increase in MVCF in patients with mitral valve prolapse remains unsettled.

Adolescent↗
PubMed2005

Late gastric prolapse with pouch necrosis after laparoscopic adjustable gastric banding.

One of the most significant complications of the gastric banding procedure is gastric prolapse. However, pouch necrosis after gastric prolapse is an extremely rare complication. We present the case of a morbidly obese 41-year-old woman who had had a laparoscopic adjustable gastric banding procedure 3 years before. She developed a pouch necrosis after a late gastric prolapse. After failure of conservative treatment, a diagnostic laparoscopy was performed. This resulted in removal of the band and the diagnosis of pouch necrosis. A laparotomy was indicated and a sleeve gastrectomy was performed. A delay in the diagnosis of gastric prolapse can lead to major complications. Initial referral to a specialized center is necessary for proper care of this complication. Failure of conservative treatment mandates early operative intervention.

Adult↗
PubMedDate not supplied

Bilateral hydronephrosis caused by vaginal prolapse.

INTRODUCTION: Even though it is uncommon, uterine prolapse can cause compression of ureters and bilateral hydronephrosis, predisposing to arterial hypertension and renal failure. Hydronephrosis consequent to cystocele and to vaginal prolapse is even rarer. CASE REPORT: This paper reports on a 59 year-old patient, Caucasian, obese and hysterectomized who presented complete vaginal prolapse with bilateral hydronephrosis and slight alteration in serum urea and creatinine. Patient underwent correction of vaginal prolapse by endoscopic suspension technique with improvement of hydronephrosis and normalization of renal function. This work emphasizes the rarity of such case and the requirement of surgical approach.

Journal Article↗
PubMed1976

Bradycardia with mitral valve prolapse: a potential mechanism of sudden death.

Eleven members of a family with a high prevalence of mitral valve prolapse were investigated. Seven had documented sinus bradycardia, and five had mitral valve prolapse. Three patients with both mitral valve prolapse and bradycardia had recurrent syncope reproduced by simple head-up tilting, and in one patient this resulted in asystole. The hemodynamic response to isoproterenol and phenylephrine administration were normal. Supine plasma norepinephrine levels were normal in all three and increased appropriately in two of three patients after tilting. Atrial pacing studies documented marked prolongation of atrial-His intervals and inability to maintain 1:1 atrioventricular conduction when paced at a rate of 120/min. These findings were reversed by atropine. This family shows a close correlation between mitral valve prolapse and potentially lethal bradycardia. Excessive vagal tone is believed to be responsible for both bradycardia and sinus arrest, which in two patients was prevented by permanent demand pacing.

Adolescent↗
PubMedDate not supplied

[Force of femoral abductors in patients with lumbar nucleus pulposus prolapse].

In 50 patients with lumbar nucleus pulposus prolapse the force of femoral abductors was determined by the test of Lovett and by means of dynamometric measurements. In 90% of patients paresis of these muscles was found. A comparison of the incidence of other signs of nerve root damage such as paresis of plantar and dorsal flexion of the foot and toes, sensory impairment on the foot and lack or weakness of ankle jerk showed that paresis of fermoral abductors was most frequent among them. This fact is explained by a particular predisposition for development of uncleus pulposus prolapse at the level of 4th and 5th intervertebral discs with resulting injury to the nerve roots L4, L5, and S1 innervating femoral abductors. The authors think that paresis of femoral abductors may be a pathognomonic sign in the diagnosis of nerve root lesions caused by nucleus prolapse at the levels L4-L5 or L5-S1. The frequency of paresis and the degree of weakness indicate the necessity of motor rehabilitation of this music group in comprehensive treatment of patients with lumbar disc prolapse.

Female↗
PubMed2006

[Effect of the width of excisional mucosa stoma ring on postoperative results of procedure for prolapse and hemorrhoids method].

OBJECTIVE: To explore the effect of the width of excisional mucosal stoma ring on postoperative results of procedure for prolapse and hemorrhoids (PPH) in the treatment of hemorrhoids. METHODS: Four hundred and eighty hemorrhoid patients were treated with circular stapler. Whether excisional mucosa stoma ring was regular or not, and its width were recorded. After follow-up from one month to 24 months,the outcomes were compared. RESULTS: The mean age of the patients was (46.6+/- 5.1) years. Regular mucosa stoma ring was excited in 303 cases,while irregular ring in 177 cases. Hemorrhoids prolapse occurred in 18 cases of the patients with irregular mucosal ring excited, while only 8 cases of the patients with regular ring excited (P< 0.01). There was significant difference in the incidence of hemorrhoids prolapse between the different groups according to different width of excisional mucosal stoma ring (P< 0.01), and the patients with postoperative hemorrhoids prolapse was lest with the width of excisional mucosal stoma ring more than 3 cm. CONCLUSIONS: The width of excisional mucosal stoma ring is one of the effecting factors of surgical outcomes. It is effective to excite mucosal stoma ring more than 2 cm,and most effective to excite mucosal stoma ring more than 3 cm.

Adult↗
PubMed1995

Failed back surgery syndrome: differentiating epidural fibrosis and recurrent disc prolapse with Gd-DTPA enhanced MRI.

The failed back surgery syndrome (FBSS) is a difficult diagnostic problem. Two of the more common causes of FBSS are epidural fibrosis and recurrent disc prolapse. Forty-five gadolinium-diethylenetriaminepenta-acetic acid (Gd-DTPA) enhanced magnetic resonance (MR) scans were performed on 43 patients to evaluate the effectiveness in differentiating recurrent disc prolapse from epidural fibrosis. Operative findings were available in 11 patients and they confirmed the pre-operative radiological diagnosis of recurrent disc prolapse in 6, epidural fibrosis in 4 and facet joint hypertrophy in 1 patient. Although the number of surgically verified cases is small, our initial experience of 100% diagnostic accuracy reflects the tremendous potential of this investigative tool. Separating epidural fibrosis from recurrent disc prolapse is crucial as patients with the former are expected to benefit from further surgery. Patients with epidural fibrosis, on the other hand, generally do not gain relief from another operation.

Adult↗
PubMed1994

Changes in macromolecular components of prolapsed intervertebral discs.

Significant quantitative differences between macromolecular components of the nuclei pulposi of prolapsed human intervertebral discs and those taken at necropsy were found. The nuclei pulposi of prolapsed discs contained about twice more collagen in comparison to control tissues. The amount of type I and type III collagens grew in a higher degree in comparison to type II of this protein. A distinctly higher solubility of the prolapsed discs collagen, together with an increased aldehyde content in solubilized collagen fractions were observed. A distinct decrease in the amount of glycosaminoglycans, especially CH-4-S and CH-6-S were found. Furthermore, a significant increase in elastin content and its susceptibility to the proteolytic action of elastase were found. The significance of these phenomena for pathobiochemistry of disc prolapse is discussed.

Adult↗