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Query: UMLS:C0033377 (prolapse)
 11,717 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 27-year-old woman had a two-week course of acute painful right proptosis with ptosis, medial conjunctival injection, and restriction of eye movements--particularly abduction. One month later, a similar remitting painful left proptosis with complete limitation of abduction developed. Computerized tomographic x-ray scanning showed marked contrast enhancement of both medial rectus muscles, documenting the presumptive diagnosis of acute orbital myositis without recourse to invasive diagnostic techniques. Myositis is a common component of idiopathic orbital inflammatory disease (orbital pseudotumor), but awareness of the rare patient with acute inflammation clinically localized to the extraocular muscles will decrease confusion with cranial nerve and cavernous sinus disease.
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PMID:Alternating proptosis. A case report of acute orbital myositis defined by the computerized tomographic scan. 19 45

Twenty cases of cobra bite in farmers from the central region of Thailand are reported. Ptosis is the earliest sign of cobra bite and is an important diagnostic indication of systemic poisoning. Restlessness, irregular breathing and mental confusion are warning signs of respiratory paralysis. Antivenom for cobra bite was administered intravenously together with symptomatic and supportive treatment; 19 patients survived and 1 died from cerebral anoxia.
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PMID:Clinical manifestations of cobra bite in the Thai farmer. 43 9

We report a case of cerebral aneurysm in a seven-year-old girl who presented with subacutely progressive third nerve palsy. To our knowledge this is the youngest reported patient with this condition. Confusion with myasthenia gravis occurred because of improvement in the patient's ptosis after intravenous edrophonium chloride. Cerebral CT revealed a hyperdense mass that was characterised on cerebral angiography as an aneurysm of the posterior communicating artery. Another occult aneurysm of the posterior cerebral artery was found at surgery. This case demonstrates that third nerve palsy due to cerebral aneurysm may affect patients at a younger age than has previously been recognised. Therefore we suggest that even young children should have aneurysm excluded by cerebral CT and angiography if they present with acquired third nerve palsy involving the pupil. In addition this case highlights the false-positive results that may occur with the edrophonium chloride test for myasthenia gravis.
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PMID:Third nerve palsy due to cerebral artery aneurysm in a child. 138 32

Three decades after it was demonstrated that nonejection systolic clicks and late systolic murmurs have a mitral valve origin and that a specific syndrome is associated with the primary degenerative mitral lesion, numerous questions remain unanswered. A principal cause of confusion is the use of the term 'prolapse', which essentially implies a pathological state, in many patients with minimal evidence of a mitral valve anomaly. It should be recognised that no specific feature, whether evaluated by high standard echocardiography or indeed by careful morphological and histological examination, can be defined which distinguishes a normal variant from a pathological valve. There is a gradation from the normal billowing during ventricular systole of mitral leaflet bodies to marked billowing. With advanced billowing or floppy leaflets, failure of leaflet edge apposition supervenes (true prolapse). This is functionally abnormal and allows mitral regurgitation. Prolapse in turn may progress to a flail leaflet and hence gross regurgitation. Relatively rare complications of this degenerative mitral valve anomaly include systemic emboli, infective endocarditis, arrhythmias and, arguably, autonomic nervous system abnormalities. An attempt is made to clarify the management of some symptoms and other aspects of mitral prolapse-including rheumatic anterior leaflet prolapse (without billowing) which remains prevalent in South Africa and Third World countries.
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PMID:Mitral valve billowing and prolapse--an overview. 144 36

The creation of a pelvic ileal reservoir is associated with inflammatory changes in the reservoir mucosa. Chronic inflammation and villous atrophy are seen in most patients with both ulcerative colitis and familial adenomatous polyposis (FAP), the two prime indications for the operation. The mucosa undergoes a form of colonic metaplasia which is demonstrable by morphological, mucin histochemical, immunohistochemical and proliferation methods. Other pathological features such as mucosal ischaemia, mucosal prolapse, granulomas and pyloric metaplasia are seen in the pouch mucosa and these changes contribute to the confusion over definitions of pouchitis. The term pouchitis denotes a chronic relapsing inflammatory condition of the reservoir which occurs in 10-20% of patients and is one of the more severe long-term complications of reservoir construction. Useful definitions of pouchitis should include clinical, endoscopic and histopathological criteria. There are close associations between pouchitis and an original diagnosis of ulcerative colitis. The cause of pouchitis is currently obscure but there is evidence to suggest it may represent a recurrence of colitis in metaplastic mucosa and may provide a useful human model for colitis. The demonstration of markedly increased proliferative activity in association with colonic metaplasia has worrying connotations. However, dysplasia has not yet been described in colitic reservoirs and very few adenomas have been seen in polyposis reservoirs. Nevertheless the clinical and pathological evidence would indicate that long-term surveillance of the reservoir mucosa by endoscopy and mucosal biopsy is warranted.
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PMID:The pelvic ileal reservoir: pathology and pouchitis. 217 47

Proctitis cystica profunda is an uncommon benign rectal condition with a range of appearances that has led to confusion in nomenclature. In a personal series of 28 patients with histologically proven proctitis cystica profunda, over 50 per cent had associated rectal prolapse. Cure of the prolapse cured the proctitis cystica profunda in 80 per cent of the patients only. Direct surgical excision (local or segmental) has not been successful and two patients have required a stoma for relief of pain.
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PMID:Proctitis cystica profunda. Incidence, etiology, and treatment. 669 41

The commonly used classifications for ptosis do not have a unifying concept, and this may contribute to confusion rather than clarification. Based on the mechanisms that cause ptosis, all cases can be classified into one or more of the following categories: (1) neurogenic; (2) myogenic; (3) aponeurotic; and (4) mechanical. While none of these mechanisms is original, this paper presents them together for the first time as an inclusive and helpful classification of ptosis. Before placing a patient in one or more of the four categories, a thorough history must be taken, an examination must be done, and appropriate laboratory tests must be performed. The thought processes then necessary to classify the ptosis should clarify not only the site of the defect but also the prognosis and range of procedures that may be used to correct the ptosis.
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PMID:The mechanistic classification of ptosis. 701 24

From the literature and our own experience, 11 cases of hemorrhage or infarction of a pituitary adenoma associated with cardiac surgery have been identified over a 13-year period. Males outnumbered females by 10 to 1. Symptoms observed were headache, lethargy, confusion, obtundation, unilateral ptosis, meiosis, and opthalmoplegia involving cranial nerves III, IV, and VI, visual field deficits, and hemiparesis. Diagnosis in most recent cases has been confirmed with computerized tomography or magnetic resonance imaging. All patients received adrenocortical steroid therapy initially. Eight patients underwent transsphenoidal hypophysectomy and all survived. One patient underwent decompression craniotomy and died. Intracranial surgery was deferred in 1 patient who survived and in another who died of a massive stroke. Residual neurological deficits were noted to be either absent, minimal, or resolving in 7 of the 9 patients who survived their initial hospitalization. While numerous mechanisms have been proposed to explain the hemorrhage and necrosis of a pituitary adenoma during heart surgery, no direct cause has been clearly identified. Surgical treatment is commonly necessary since untreated pituitary apoplexy is often fatal. Transsphenoidal hypophysectomy with decompression is the preferred method of treatment with a low perioperative mortality and fairly good long-term prognosis.
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PMID:Pituitary adenomas complicating cardiac surgery: summary and review of 11 cases. 777 76

The present editorial, besides providing a historical review, offers a succinct definition and a new classification and terminology. It is hoped that this or a similar classification would clarify some of the confusion surrounding the diagnosis of mitral valve prolapse. The current echocardiographic criteria are reviewed. Some difficulty in the diagnosis of milder forms of prolapse is inevitable because a distinction between normal bulging and excessive hooding may be subtle in such cases. The proposed criteria using multiple echocardiographic cross sections (rather than the long-axis view alone) is more likely to provide a comprehensive visualization of several components of the leaflets and avoid errors of underdiagnosis of localized myxomatous prolapse abnormality. The criteria and discussion are based on the author's experience and interest in the diagnosis of this condition and clinical correlations with intraoperative findings. If the cardiac surgeons and the echocardiologists could agree on a common terminology and classification scheme, it could result in better anatomic correlations of the echocardiographic findings in this condition and potentially result in improved patient care.
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PMID:Echocardiographic diagnosis of mitral valve prolapse. 806 Jun 45

Palmar prolapse of the flexor tendons as a result of attenuation of the A1 and A2 pulleys occurs in rheumatoid arthritis and other conditions in which the joints of the fingers are chronically flexed. The flexor tendons may be palpable and sometimes visible as longitudinal bands crossing the palm. This can lead to confusion with the palmar bands of Dupuytren's disease. These bands are illustrated in a small series of patients and a serious complication of a misdiagnosis of Dupuytren's disease is presented. The pathogenesis of these palmar bands in rheumatoid arthritis is discussed.
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PMID:Palmar bands in rheumatoid arthritis and other chronic conditions of the upper limb. 877 80


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