Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0019270 (hernia)
 15,856 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In a prospective follow-up study of 5,571 general surgical patients at 11 hospitals (23 departments) in Israel, 1,487 patients underwent operations for hernia (all types) and were screened daily for the development of postsurgical wound infection. Infection developed in 68 (4.6 per cent) at the site of the incision. Fourteen factors were analyzed for the presumed effect on the risk of infection; only four were significant in a multivariate model. Of these factors (old age, incarcerated or recurrent hernia, coexistent infection and drains), the introduction of drains had the strongest effect (relative risk equaled 4.1; p less than 0.001). Drains increased the risk in all the participating hospitals and in any category of patient. They prolonged the period a wound was susceptible to bacterial infection from nine to 16 days. The risk increased linearly with the duration of the drainage. The over-all proportion of patients who had a drain inserted was 19 per cent, with hospitals varying from 9 to 40 per cent of patients operated upon (p less than 0.001). Our findings suggest that the risk of an infection associated with drains may outweight their worth. Furthermore, there is no concensus among surgeons on the need for drains. Some surgeons use drains indiscriminately and others, rarely.
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PMID:The Israeli Study of Surgical Infection of drains and the risk of wound infection in operations for hernia. 218 14

In cirrhotic patients, umbilical hernias occur almost exclusively when longstanding ascites is present. Umbilical hernias expose cirrhotic patients to potentially life-threatening complications such as strangulation (which can be precipitated by rapid removal of ascitic fluid) and rupture (which is usually preceded by cutaneous ulcerations on the surface of the hernia). In cirrhotic patients, prevention of umbilical hernias is based on prevention of ascites. When prevention has failed, medical treatment of ascites should be first attempted. In patients in whom medical treatment is effective, and after ascites has disappeared, surgical treatment of umbilical hernia can be safely performed in most cases. In patients in whom medical treatment is ineffective and who develop refractory ascites, treatment strategy for umbilical hernia depends on the presence or absence of indication for liver transplantation. In patients who are candidates for liver transplantation, careful local care with pressure bandage must be performed until transplantation. Herniorrhaphy must be performed at the time of transplantation. In patients with refractory ascites, and who are not candidates for transplantation, portocaval shunt, transjugular intrahepatic portocaval shunt (both followed by surgical herniorrhaphy when ascites has disappeared) or concomitant peritoneo-venous shunt and herniorrhaphy should be considered. In contrast to umbilical hernias, groin hernias are not markedly influenced by ascites. However, ascites is a major risk factor for surgery. Therefore, surgical repair should not be recommended in patients with ascites and poor liver function. In cirrhotic patients with incisional hernia, prosthetic devices should be avoided because of the high risk of bacterial infection.
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PMID:Abdominal wall hernias in the setting of cirrhosis. 930 26

Within the last decade hernia surgery has changed from suture repair to mesh repair. Biomaterials, and multifilaments in particular, are thought to increase the risk of infection. Therefore, the aim of this study was to study the influence of the presence of either a monofilament or a multifilament mesh material on the bacterial infection risk. The filament surface of a monofilament and a multifilament mesh were calculated on the basis of a theoretical model. The adherence of Staphylococcus aureus was measured in vitro by fluorescence analysis. Additionally, the two mesh materials (8-mm platelets) were implanted subcutaneously in Sprague-Dawley rats with daily surveillance for clinical signs of infection. After 7 days the meshes were explanted for histological and microbiological analysis. Calculations of the mesh surface area revealed a higher level for the multifilament mesh. The extent of adherent bacteria corresponded to the estimated filament surface in vitro. In vivo, the implantation of meshes in the presence of 5 x 10(6) S. aureus did not show an increased infection rate in rats with either monofilament or multifilament material, compared to the control groups (mesh implantation without S. aureus contamination). However, after 7 days bacteria were still detectable in the majority of the implantation sites, and a clinically inapparent intensification of local inflammation and fibrosis was induced. The increased surface area of a multifilament meshes promotes the persistence of bacteria in the implant bed, though this alone is not sufficient to create a clinically apparent infection. This might explain the development of mesh-related infections after a delay of several months or even years. In vivo, the adherence of bacteria to the implant material depends on the surface area, which favors the use of monofilament materials.
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PMID:Do multifilament alloplastic meshes increase the infection rate? Analysis of the polymeric surface, the bacteria adherence, and the in vivo consequences in a rat model. 1241 22

A local inflammatory and potentially painful response, of which the ultimate cause is unknown, has been described in nervous tissues in contact with degenerated disc material in patients with low back and leg pain. With the rationale that a possible cause of such inflammation could be bacterial infection, we utilized PCR (polymerase chain reaction) amplification of the 16S rRNA (ribosomal RNA) gene followed by gene sequencing, to investigate whether bacterial DNA might be detected in the degenerative discs of 10 patients operated for disc herniation or post-discectomy syndrome. One patient with disc hernia harbored DNA homologous to Bacillus cereus, and in one patient suffering from post-discectomy syndrome, Citrobacter braaki/freundii DNA was detected. The finding demonstrates that 16S rRNA PCR can be a useful tool in search of bacterial DNA in degenerated discs, which in turn may be indicative of low-grade infection, manifesting itself only as pain rather than as clinical infection.
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PMID:Detection of bacterial DNA in painful degenerated spinal discs in patients without signs of clinical infection. 1513 61

A polyester hernia patch has received extensive attention in mesh hernia repair. However, it is still a challenge to develop polyester-based implants with inherent antibacterial properties due to the lack of active functional groups. In this study, poly(butylene succinate-co-butylene aspartate) (PBSA) was constructed by introducing aspartic acid on a polybutylene succinate (PBS) polyester chain (PBSA). Antimicrobial treatment was conducted by grafting levofloxacin (Lv) on the surface of a PBSA polymer (PBSA-g-Lv). In vitro antibacterial test results showed that PBSA-g-Lv had sufficient local antimicrobiotic effects against Staphylococcus aureus and Escherichia coli and no side effect on L929 cells was observed. Furthermore, almost no change was observed in the thermodynamic properties of PBS and PBSA; in vivo tests demonstrated that this contact-active antibacterial PBSA-g-Lv nanofiber is a promising material to fulfill the dual functions of promoting tissue regeneration and preventing bacterial infection. The presented data confirmed that an antibiotic surface modification of PBSA polyesters was expected to be used as hernia repair materials.
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PMID:Hydrophilic and degradable polyesters based on l-aspartic acid with antibacterial properties for potential application in hernia repair. 3163 2