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Query: UMLS:C0019270 (hernia)
 15,856 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The case presented here is a three-month-old male infant with the Beckwith-Wiedemann's syndrome. Clinically, the patient was characterized by macroglossia, visceromegaly, umbilical hernia, microcephalus and other multiple malformations such as facial flame nevus or ear lobe grooves. The patient died of bronchopneumonia at the age of three months, and an autopsy was performed. Morphological examination revealed adrenal cytomegaly, hyperplasia and hypertrophy of the pancreatic islets, adrenal rest tissue in the right testis or hypertrophy of muscle fibers of the tongue associated with fibrous degenerative change, in addition to bronchopneumonia of the lung, causing his death. On electron microscopical examination, the cytomegalic cell of the adrenal was characteristic of large pleomorphic nucleus and granular substances with high density in the cytoplasm. In this case, thorough histologic search revealed no evidence of tumorous growth in the organs, though the exomphalos-macroglossia-gigantism syndrome has been of interest in its relationship to the occasional occurrence of Wilms tumor, adrenal carcinoma or other tumors.
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PMID:Beckwith-Wiedemann's syndrome--a report of an autopsied case--. 43 92

Management of the pelvic space after rectal excision is still problematic. Two methods have to be preferred: (1) closed suction lavage drainage and (2) open wound plugging; then the pelvic floor best remains unsutured. Plugging is always indicated in difficult pelveoperitoneal suture, unsatisfactory hemostasis and fecal contamination of the pelvic space. Retardation of wound healing is compensated for by more comfort for the patient and elimination of late complications, compared with those with partially closed or secondary opened wounds. The sacroperineal scar is the origin of a lot of complaints and morbidity. The most important are: infectious complications and persistent fistula (17.3%), pseudosinus perinealis (10%), perineal hernia and genital prolapses (16%), urologic complications (recidivating infections [26.9%], changes of the position of the urinary bladder [56%], secondary retroperitoneal fibrosis with urinary restriction [19.2%] or hydronephrosis [3.8%], disturbances of bladder emptying [36.5%], frequently combined with neurogenic lesions because of intraoperatively dissected autonomous pelvic nerves), local recurrence of carcinoma (17.3% in reexamination, but still much more important), and pain, often of unknown origin (34%).
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PMID:[Height of rectum amputation. Management, complications, disease significance]. 68 28

A series of 207 cases of carcinoma of the cardia and thoracic oesophagus was reviewed. Ten patients (9-8% of those with carcinoma of the cardia) had a hiatal hernia with a coexisting adenocarcinoma. Five other patients (2-4%) had long-standing records of hiatal hernia, and chronic peptic oesophagitis with stricture before the development of carcinoma. In the cases of hiatal hernia coexisting with carcinoma, there is insufficient evidence of the hernia predisposing to carcinoma. The relationship is thought to be purely coincidental. However, malignant changes may occur in long-standing cases of chronic oesophagitis with peptic stricture.
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PMID:Carcinoma of the cardia and thoracic oesophagus coexisting with and following sliding hiatal hernia and peptic stricture. 88 49

A retrospective review of experience with small-bowel obstruction at the University Hospital in Birmingham for a ten-year period (January 1963 through December 1972) revealed 465 episodes of obstruction in 415 patients. The mortality was 4% in obstruction due to adhesions, and 28% in obstruction caused by carcinoma; overall mortality was 8%. Intra-abdominal adhesions were the cause of 69% of cases. Malignant obstruction (mostly from metastatic disease) was the second most common cause of obstruction, and external hernia was third. Delay in diagnosis and inappropriately prolonged used of long intestinal tubes added to the mortality and can be avoided. We suggest a plan for prompt, consistent diagnosis and recommend more liberal use of the barium meal in questionable cases.
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PMID:Small-bowel obstruction: a review of 465 cases. 93 2

A clinical study of 70 patients with hernia hiatus oesophagi (59 sliding hernias, 11 paraoesophageal), of whom 22 had received primary surgery, 33 medical treatment and 15 with no discomfort from the hernia had no primary treatment at all. None of the patients in any of these groups had undergone an operation later. A follow-up examination in 1972-73 was achieved in 43 of the 70 patients (16 of those with surgery, 18 with medical treatment and 9 with no treatment); 6 of the others did not attend the follow-up and 21 had died. Of the 16 operated patients, 8 stated they were free from discomfort and 8 that they had improved (7 of the latter only after additional medical treatment). Of the 18 patients who had received only medical treatment, 8 stated that they were free from discomfort (2 of them not until the medication had been changed), 6 that they had improved, 2 had noted no improvement, and 2 a deterioration even though their medication had been changed. Of the 9 untreated patients, 4 stated that they still had no discomfort and 5 that discomfort had materialised later; subsequent medical treatment had eliminated the discomfort in 2 of the later and produced an improvement in 2 more; the 5th patient had not reacted to medical treatment - the follow-up disclosed an inoperable gastric carcinoma.
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PMID:Hiatal hernia. Follow-up of a ten-year material. 106 13

The significant increase in the number of people older than seventy forces the physician to be acquainted with both psychological and physical alterations induced by aging and to devote an ever increasing proportion of time for recognition and treatment os such alterations. In the medical sense, the biological and physiological age is more important than the chronological age. With increasing age there is--especially concerning the digestive tract and its accessory organs--a rise in the incidence of organic affections and a decline in the frequency of functional disorders. Besides it is wise to know, that the increasing age there is often a coexistence of multiple degenerative disorders and disease states, involving many body systems and organs. On the background of this recognition it is also important to know, that prognosis too varies with age because of the coexistence of individually prognosticated disease states and moreover to realize, that elderly patients do not tolerate invasive and prolonged surgical procedures. Structural or functional disturbances of the digestive organs by aging processes do not cause death per se, but can become one important factor; degenerative sclerotic vascular alterations bear relationship to the poorly contractile vasculature that brings up difficulties in the control of hemorrhagic gastroduodenal ulcers. Many gastrointestinal disorders in elderly patients occur with an equal frequency in younger patients, some are more common in the geriatric population; these include hiatal hernia, carcinoma of esophagus, stomach, pancreas, bile ducts and colon, intestinal obstruction (ileus) by neoplastic growth, gallstone ileus, external hernia and operative adhesions and especially diverticular diseases of the colon and its complications and ischemic colitis by mesenteric vascular occlusion. Cirrhosis of the liver is often diagnosed for the first time in the older age groups while acute viral hepatitis uses to run a cholestatic course and is therefore often misdiagnosed as mechanical obstruction. In general history is difficult to obtain, the response of the organism with temperature and white blood count to stress is often delayed and rigidity associated with an underlying inflammatory disease involving the peritoneum is often delayed and rigidity associated with an underlying inflammatory disease involving the peritoneum is often atypical. Because of this limited reaction to severe stress, early surgical intervention is imperative in the elderly patients.
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PMID:[Problems of the so-called geriatric gastrointestinal diseases]. 120 46

We carried out a retrospective analysis of about 100 surgical cases of mediastinal, pleural, chest wall and pulmonary disorders in order to determine the clinical application and efficacy of MRI (magnetic resonance imaging) of the thorax. Coronal and/or axial image of T1-weighted images were obtained in all cases, and T2-weighted or gadolinium-DTPA contrast-enhanced T1-weighted images were additionally obtained in several selected cases. All MR images were compared with findings of chest X-ray, CT and IVDSA (intravenous digital subtraction angiography) as appropriate. As a result, MR images were considered to provide additional information to that obtained by conventional techniques of chest X-ray and CT, in demonstrating chest wall invasion of pulmonary carcinoma, detecting hilar masses, which were difficult to distinguish from vessels, and in defining mediastinal masses. The anterior segment of the diaphragm is clearly depicted, aiding the differentiation of Morgagni hernia from other entities. Tuberculoma showed peripheral enhancement in Gd-enhanced T1 WI, which was distinctly different from the enhancing pattern of carcinomas. With the use of surface coil, the pleura and chest wall anatomy were clearly demonstrated. It is hoped that the wide application of this technique will increase the diagnostic accuracy of chest wall tumor invasion.
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PMID:[MRI of the thorax; clinical application and efficacy in 100 thoracic diseases]. 130 34

Two cases of gall-stone ileus during the past months have encouraged us to discuss the epidemiology, pathogenesis, diagnosis and therapy. This pathology is not as rare as one thinks and represents 23% of cases of mechanical ileus of the small intestine in patients over 65 years of age, thus being the third cause after stenosis due to carcinoma and incarcerated hernia. The importance of this illness is due to two factors: the diagnostic difficulties because of a periodic symptomatology with often a lack of typical radiologic signs and the still important mortality of 5 to 10% today. We present the casuistic of seven cases which have occurred over the last 15 years in our hospital and compare our experience with those of the literature. We discuss the therapeutic problem of enterolithotomy or one-stage repair. The main point for a reduction in mortality is an early diagnosis with the consequent reduction of the time from the appearance of the ileus to the operation.
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PMID:[Gallstone ileus--still a current disease]. 159 51

Eighteen patients were examined; they were suffering from small bowel obstruction due to adhesions (7 cases), hernia (3 cases), carcinoma (2 cases), metastasis from melanoma (1 case), radiation enteritis (2 cases), intramural hematoma (2 cases), and peritoneal carcinosis (1 case). CT capabilities in showing the site and the cause of obstruction were evaluated. CT was performed after conventional radiology in 13 cases, while in 5 cases it was the first exam and demonstrated the condition as an occasional finding. In all cases i.v. contrast agents were administered. Filling of the intestinal loop by oral contrast agent was never performed since the hypodense fluid present in the distended intestinal loops allowed good evaluation of intestinal walls. CT always showed the level of the obstruction thanks to the presence of the distended loops (phi: 4-8 cm) above the condition and of collapsed loops below. In 8/18 cases (44%) it was possible to show the cause of the obstruction. Those due to neoplasms, herniae and intramural hematomas were correctly diagnosed. On the contrary, it was not possible to identify the cause of the obstructions due to adhesions, radiation enteritis and peritoneal metastases because of the absence, in such cases, of specific parietal alterations. According to our results, CT is suitable in patients suffering from small bowel obstruction because it allows: to always show the site of the obstruction and, in some cases, its cause; to diagnose closed loop obstructions; to obtain a simultaneous staging in neoplastic patients.
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PMID:[The potentials of computed tomography in the study of mechanical ileus of the small intestine]. 178 Apr 62

It is the practice of some gynecologists and general surgeons to preoperatively evaluate the colon with a barium enema (BE) examination to exclude potential intestinal involvement or coexistent disease in patients undergoing pelvic or hernia operations. This practice appears to be based on anecdotal data with few studies specifically evaluating its usefulness. We retrospectively evaluated the records of 190 patients at William Beaumont Army Medical Center during 1986 to 1987 who received a preoperative BE prior to total abdominal hysterectomy (TAH) or inguinal hernia repair (IHR). The tumor registry charts of 59 patients diagnosed with carcinoma of the colon and rectum during the same period were also cross-checked to determine if any were detected during preoperative evaluation for TAH or IHR. BE findings were considered significant if they altered surgical management or asymptomatic carcinoma was detected. Of 86 patients screened before TAH by BE, eight had abnormal findings with subsequent colonoscopy revealing four with adenomatous polyps, one of which required surgical resection. Of 104 patients screened before IHR by BE, 15 had abnormal findings with subsequent colonoscopy revealing five patients with adenomatous polyps and two with adenocarcinoma. Screening preoperative BE had a low yield of clinically significant findings, which was even lower in the subgroup with carcinoma. There was no apparent relationship between findings and age in our study. Our results suggest that the use of routine preoperative BE has a low yield and should be performed only if clinical symptoms or findings suggest a need for this study.
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PMID:The yield of barium enema in patients undergoing inguinal hernia repair or abdominal hysterectomy. 190 94


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