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

The high incidence of arrhythmias in patients with heart failure, hypertension, valvular heart disease, or mitral walve prolapse suggests a strong link between wall motion abnormalities and arrhythmias. A potential common mechanism underlying these observations may be that overload leads to electrophysiologic changes and facilitates arrhythmias. This article summarizes the interaction between changes in atrial and ventricular loading conditions and repolarization. Most experimental and clinical studies demonstrated 1) a reduction of action potential duration and refractoriness, 2) development of early afterdepolarizations, and 3) ectopic beats originating from these afterdepolarizations. Discrepancies between studies are related to different study designs, i.e., varying magnitude, velocity, and timing of increased load, the level of repolarization at which action potential duration is measured as well as different animal species. Direct effects of increased load on repolarization are most likely caused by activation of stretch-activated nonselective cation ion channels and changes in calcium handling. Current antiarrhythmic drug therapy is aimed at electrical disorders as the primary cause of arrhythmias. If mechanical disorders play a central role in the genesis of cardiac arrhythmias, future treatment should be directed at restoring a more normal mechanical function of the heart. Additional studies will further clarify the nature and clinical significance of load-related changes in repolarization and arrhythmogenesis.
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PMID:Load-induced changes in repolarization: evidence from experimental and clinical data. 1151 93

A 61-year-old woman had acromegaly associated with mitral regurgitation (MR) resulting from prolapse of the posterior mitral leaflet. At the age of 51 years, the patient was diagnosed with hypertension and a cardiac murmur. She had the characteristic acromegalic appearance, but without visual disturbance. Blood chemistry revealed an elevated plasma concentration of growth hormone and glucose intolerance. Echocardiography showed remarkable dilation of the left ventricle and prolapse of the anterolateral commissure with severe MR. Magnetic resonance imaging of the brain revealed a pituitary microadenoma. MR was successfully corrected by quadrangular resection of the posterior leaflet, including the prolapsed portion, and prosthetic ring annuloplasty. The patient recovered uneventfully.
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PMID:Mitral valve repair in a patient with acromegaly: case report. 1203 Mar 53

In 1998, a multidisciplinary group of researchers investigated women's reproductive health in two rural villages in Giza, Egypt using data from clinical examinations and laboratory tests. In addition, a questionnaire supplemented with in-depth interviews illuminated women's perceptions of illness and the sociocultural context of the community. Examining a random sample of 509 married, nonpregnant women, the researchers found that the vast majority of these women suffer from a spectrum of gynecological and related conditions. Beyond reproductive tract infections, which affect roughly half of the women, genital prolapse afflicts 56% and anemia 63%. Suspicious cervical cell changes (11%) and cervical erosion (22%) in women were noted. Moreover, related conditions were also highly prevalent: women suffered from urinary tract infections (14%), obesity (43%), and hypertension (18%). The team also discovered that two-thirds of women with symptoms had not sought care. Factors other than the physical accessibility, inadequacy in the quality and nature of available health services, and low priority that women place on their health have all contributed to women's lack of seeking treatment. This study suggests that a multidisciplinary approach to medical provision, taking women's perceptions into account is the most effective way to address reproductive health and ill health in communities of the developing world.
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PMID:Rural Egyptian women bear heavy disease burden. 1229 56

Although myasthenia gravis (MG) has frequently been associated with other autoimmune disorders, it has only rarely been reported in conjunction with diseases of the nervous system. A 74-year-old patient with hypertension suddenly presented left unilateral ptosis and mastication disorders. Clinical examination showed a concomitant loss of strength distally and reduced deep tendon reflex. Electrophysiologic data indicated a diagnosis of MG and chronic inflammatory demyelinating polyneuropathy; acetylcholine receptor antibody was elevated at 4.1 nmol/L (normal < 2 nmol/L). Improvement was rapid after initiation of pyridostigmine in association with corticosteroid (1 mg/kg/day). One month later, the cranial nerve deficit disappeared and strength was normal. It is likely that a basic abnormality of immune regulation was responsible for the emergence of diseases with different clinical presentations, but similar immunopathogenesis. Corticosteroid seemed to be the most effective treatment.
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PMID:[Ptosis and mastication disorders revealing concurrent myasthenia gravis and chronic polyradiculoneuritis]. 1248 7

The authors describe the disease of a 22-year-old woman treated from the age of 13 years on account of Hodgkin's lymphoma by irradiation and cytostatic treatment. On account of a relapse of lymphoma at the age of 14 years megachemotherapy with subsequent transplantation of autologous bone marrow. In the course of eight years of the follow up gradual development of constrictive pericarditis with exsudate. Concurrently progression of mitral insufficiency based on valvular prolapse resulting from radiation. During the last two years refractory systemic hypertension resistant to treatment. At the peak of the disease development of cardiac tamponade and cardiac cachexia with anasarca. After anamnestic, clinical and haemodynamic analysis total pericardetomy was indicated and mitral valve replacement performed. The operation led to improvement of the patient's condition, systemic hypertension receded completely. The patient is in permanent remission.
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PMID:[Cardiac damage in a young woman with Hodgkin's disease and long term survival after combination therapy and bone marrow transplantation]. 1266 28

High-flow AVFs are a challenging problem in the pediatric age group. Venous occlusive changes develop as part of the dynamic response to these fistulas. The development of adequate venous collateral flow circumvents the destructive sequelae of longstanding venous hypertension. Without adequate collaterals, venous hypertension develops. Venous hypertension interferes with CSF resorption, resulting in increased brain water. Ventriculomegaly and tonsillar prolapse commonly develop and are reversible if therapeutic intervention is done in a timely fashion. If left untreated, chronic venous ischemic changes develop, which result in delay in important developmental milestones.
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PMID:Hydrovenous disorders in pediatric intracranial arteriovenous fistula. 1280 40

We performed a retrospective study of all patients referred for external cephalic version (ECV) at > or = 36 weeks gestation from 1993 to 2000. Exclusion criteria included ominous fetal heart rate changes, complete or multiple loops of nuchal umbilical cord, extension of the fetal head, oligohydramnios and poorly controlled hypertension. Three groups were compared: spontaneous cephalic version (SCV), ECV attempted (ECV) and ECV not attempted (NoECV). A total of 289 patients were referred. ECV was attempted in 191, 118 by one operator (D.W.S.). ECV was successful in 98/191 (51%) attempts. Spontaneous reversion to breech after successful ECV occurred in 6/98 (6%). There were 4 complications: 1 occult cord prolapse, 2 nonreassuring fetal heart patterns, and 1 placental abruption; all led to nonemergent cesarean delivery (CD). The CD rate (SCV 2/18, 11%; ECV 114/179, 64%; NoECV 49/51, 96%) was highest in the no-attempt group (p=0.001). The CD rate after successful ECV was 29/91 (32%). Maternal postdelivery complications (SCV 1/16, 6%; ECV 24/161, 15%; NoECV 13/48, 27%) and neonatal complications were not significantly different. With careful attention to contraindications, ECV can be performed with few complications. ECV lowers the CD rate.
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PMID:External cephalic version: an approach with few complications. 1292 Mar 44

Diminutive kidney, hypoplasia or atrophic pyelonephritis, may be the cause of hypertension, lumbar or abdominal pain, obscure gastrointestinal symptoms or chronic urinary infection accompanied by chills and fever. A hypoplastic kidney is prone to infection and stone formation.Diagnosis includes meticulous x-ray examination and renal function studies employing the more accurate quantitative phenolsulfonphthalein test of each kidney. Nephrectomy is the treatment for unilateral disease causing symptoms; localized atrophic pyelonephritis is amenable to partial resection. Since urinary stasis invites infection, obstructing ureteral strictures should be dilated. Pyelectasis, secondary to ptosis, and ureteropelvic obstruction should be corrected by nephropexy or plastic repair. These conservative measures may prevent renal destruction.SIXTEEN PATIENTS WERE SUBJECTED TO NEPHRECTOMY: Six because of persistent pain and chronic infection and ten because of hypertension. The six with pain and chronic urinary infection were relieved. In six of the ten with hypertension, the disease recurred within six months to seven years.
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PMID:The diminutive kidney; congenital hypoplasia and atrophic pyelonephritis. 1328 42

The administration of magnesium sulphate is a proposed novel therapy for Irukandji syndrome'. In this non-randomized, unblinded case series, data from ten patients who received magnesium salts are reviewed. Magnesium sulphate boluses of 10 to 20 mmol, in the six patients for which there was adequate data, reduced pain scores immediately after administration from 8.7+/-1.5 to 2.8+/-2.8 (Wilcoxon rank-sum test, P=0.03). In ten patients blood pressure decreased with a mean difference of -18 mmHg in mean arterial pressure. Magnesium requirements in individual patients varied markedly. Pain on injection occurred in four patients, three of whom had received peripherally administered magnesium chloride, and one patient reported transient ptosis after administration of magnesium sulphate 166 mmol over 18 hours in the setting of severe Irukandji syndrome. Magnesium sulphate administration appears to attenuate pain and hypertension in Irukandji syndrome and warrants further evaluation in this setting.
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PMID:Early experience with magnesium administration in Irukandji syndrome. 1611 7

The Saethre-Chotzen syndrome (SCS) is an autosomal dominant craniosynostosis syndrome with uni- or bilateral coronal synostosis and mild limb deformities. It is caused by loss-of-function mutations of the TWIST 1 gene. In an attempt to delineate functional features separating SCS from Muenke's syndrome, we screened patients presenting with coronal suture synostosis for mutations in the TWIST 1 gene, and for the Pro250Arg mutation in FGFR3. Within a total of 124 independent pedigrees, 39 (71 patients) were identified to carry 25 different mutations of TWIST 1 including 14 novel mutations, to which six whole gene deletions were added. The 71 patients were compared with 42 subjects from 24 pedigrees carrying the Pro250Arg mutation in FGFR3 and 65 subjects from 61 pedigrees without a detectable mutation. Classical SCS associated with a TWIST 1 mutation could be separated phenotypically from the Muenke phenotype on the basis of the following features: low-set frontal hairline, gross ptosis of eyelids, subnormal ear length, dilated parietal foramina, interdigital webbing, and hallux valgus or broad great toe with bifid distal phalanx. Functional differences were even more important: intracranial hypertension as a consequence of early progressive multisutural fusion was a significant problem in SCS only, while mental delay and sensorineural hearing loss were associated with the Muenke's syndrome. Contrary to previous reports, SCS patients with complete loss of one TWIST allele showed normal mental development.
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PMID:Saethre-Chotzen syndrome caused by TWIST 1 gene mutations: functional differentiation from Muenke coronal synostosis syndrome. 1625 95


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