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

An account is given of the treatment of peptic oesophagitis, in which the importance of repairing a hernia which is producing peptic ulceration is emphasized. Mobilization of the oesophagus muct be carried out as far up as is necessary for the hernia to reduce without tension. When there is a firm stricture which will not respond to treatment, associated with shortening of the oesophagus, resection and interposing a loop of jejunum is the operation of choice which in this series has been performed without mortality.
 ...
PMID:The diagnosis and treatment of peptic oesophagitis. 1378 23

Esophagitis caused by the reflux of acid gastric juices through an incompetent sphincter at the junction of the esophagus with the stomach is now recognized as a common cause of upper abdominal and thoracic symptoms frequently simulating heart, stomach or gallbladder disease. While these symptoms are occasionally mild and transient, under certain circumstances permanent, irreversible and seriously disabling changes may occur in the lower esophagus. The usual cause is a sliding hiatal hernia. Although mild symptoms can often be relieved by simple means, advanced disease may require a major surgical procedure to relieve scar tissue stricture of the esophagus which may eventuate and permanently disturb the swallowing mechanism. Hiatal hernia causing displacement of the cardioesophageal junction, the most common cause of esophagitis, can be corrected either by transabdominal or transthoracic surgical procedures directed toward reduction of the hernia. Fixation of the stomach to the abdominal wall in a position of downward traction has been used as a simple and successful means of correcting the hernia.
 ...
PMID:PEPTIC ESOPHAGITIS. ITS SURGICAL SIGNIFICANCE. 1422 38

Hiatal hernias are usually classified into three distinct types: type I, sliding hernia; type II, paraesophageal hernia; and type III, a combination of type I and II hernias. Presentation of type I hernia is so-called reflux symptoms, in contrast with the symptoms associated with mechanical obstruction of the herniated stomach in type II and III hernias. Surgical indications for type I hernia depend upon the severity of esophagitis. In type II and III hernias, severe symptoms and complications represent the chief indications for repair. Totally intrathoracic stomach hernias generally present such a risk of volvulus, strangulation, and perforation that surgery is indicated even in asymptomatic and uncomplicated cases. Although the pathophysiology is different, the Nissen procedure is the surgical procedure of choice for both types of hiatal hernia. Since the first report in 1993, the laparoscopic Nissen procedure has gained wide acceptance. We have so far experienced 26 cases of hiatal hernia, 18 of type I and 8 of type II and III hernias. We used the laparoscopic Nissen procedure in all cases. There were no conversions to the open procedure. Hiatal hernia recurred only in one case with a short esophagus preoperatively. The laparoscopic Nissen procedure is here to stay for the repair of hiatal hernias regardless of their type.
 ...
PMID:[Laparoscopic repair of esophageal hiatal hernia]. 1457 11

We successfully used argon plasma coagulation (APC) to treat two cases of dialysis patients with hemorrhagic gastric angiodysplasia. Gastric angiodysplasia is recognized as an important cause of gastrointestinal bleeding. Angiodysplastic lesion confined to the gastric antrum was first described in 1953 and named gastric antral vascular ectasia (GAVE). The condition is characterized as submucosal capillary dilatation and fibromuscular hyperplasia. The typical finding of GAVE is the so-called watermelon stomach, attributable to vasodilatation. In case 1, a 69-year-old man was introduced continuous ambulatory peritoneal dialysis (CAPD) in July 1997 because of chronic renal failure due to nephrosclerosis. He was hospitalized for severe anemia in December 1997. Gastrointestinal fiberscopy (GIF) showed oozing in the antrum, and gastritis and esophagitis with sliding hernia. Famotidine was started and recombinant human erythropoietin (rHuEPO) was used for anemia. However, the severe anemia did not improve. The patient was hospitalized again for severe anemia and hematemesis. Another GIF showed typical watermelon stomach, which corresponded with GAVE. An APC was performed without complications. Three months later, the anemia was improved, and the dose of rHuEPO was reduced. In case 2, a 57-year-old woman was introduced to hemodialysis in 1998 for uremia due to nephrosclerosis. In October 2000, she was hospitalized for rHuEPO-resistant anemia. A GIF showed oozing in the antrum with diffuse vasodilation in the antrum; GAVE was diagnosed. An APC was carried out without complications. Three months later, anemia was improved. Recently, gastric angiodysplasia was reported to be an important complication in dialysis patients and was recognized as an important cause of rHuEPO-resistant anemia. Argon plasma coagulation is an effective treatment for gastric angiodysplasia in patients on dialysis.
 ...
PMID:Gastric angiodysplasia in patients undergoing maintenance dialysis. 1476 50

A sliding hiatus hernia disrupts both the anatomy and physiology of the normal antireflux mechanism. It reduces lower oesophageal sphincter length and pressure, and impairs the augmenting effects of the diaphragmatic crus. It is associated with decreased oesophageal peristalsis, increases the cross-sectional area of the oesophago-gastric junction, and acts as a reservoir allowing reflux from the hernia sac into the oesophagus during swallowing. The overall effect is that of increased oesophageal acid exposure. The presence of a hiatus hernia is associated with symptoms of gastro-oesophageal reflux, increased prevalence and severity of reflux oesophagitis, as well as Barrett's oesophagus and oesophageal adenocarcinoma. The efficacy of treatment with proton pump inhibitors is reduced. Our view on the significance of the sliding hiatus hernia in gastro-oesophageal reflux disease has changed enormously in recent decades. It was initially thought that a hiatus hernia had to be present for reflux oesophagitis to occur. Subsequently, the hiatus hernia was considered an incidental finding of little consequence. We now appreciate that the hiatus hernia has major patho-physiological effects favouring gastro-oesophageal reflux and hence contributing to oesophageal mucosal injury, particularly in patients with severe gastro-oesophageal reflux disease.
 ...
PMID:The role of the hiatus hernia in gastro-oesophageal reflux disease. 1537 32

Oxygen free radicals trigger arachidonic acid peroxidation. The end-products of this reaction are malonyl dialdehyde (MDA) and conjugated dienes (CDs). The pattern of changes of MDA and CD concentrations in serum and esophagus mucosa homogenates were estimated in patients with GERD. The study was conducted on a group of 92 patients. They were divided into a non-esophagitis and co-existent esophagitis subgroup. The presence of inflammation was confirmed by means of pathomorphological examination. Results were verified against upper gastrointestinal tract endoscopy outcomes. The measurements were taken before and 8 weeks after anti-GERD treatment. Results were compared against 20 patients awaiting hernia repair. In both groups MDA serum concentrations before treatment were significantly different from the control group (2.02 nmol/mL in group I and 3.92 nmol/mL in group II). It decreased significantly after treatment in group II (2.72 nmol/mL) and insignificantly in group I. Also DS serum concentrations before treatment was significantly different comparing to the control group (1.34 nmol/mL in group I, and 2.13 nmol/mL in group II). Like MDA, dienes' concentrations decreased significantly after treatment in group II and insignificantly in group I. MDA and DS tissue concentrations were always higher than the serum ones. Both before and after treatment they displayed statistically significant differences between the esophagitis and non-esophagitis groups. Oxygen free radicals measured by means of MDA and DS serum and tissue homogenate concentrations rise significantly in patients with GERD compared to the control group. Arachidonic acid peroxidation products' concentrations were significantly higher in patients with GERD and esophagitis than in the non-esophagitis group.
 ...
PMID:[Effect of arachidonic acid peroxidation products on the development of gastroesophageal reflux disease]. 1551 Aug 90

Gastroesophageal reflux disease (GERD) is defined as gastroesophageal reflux resulting in symptoms or in injury to the esophageal epithelium. Although the medical management of GERD has improved, an increasing number of laparoscopic antireflux surgical procedures are being performed. Barium studies, endoscopy, manometry, and pH monitoring are all integral components of preoperative evaluation. Barium swallow examination must allow critical evaluation of esophageal peristalsis, the presence and extent of gastroesophageal reflux, and complications including esophagitis, stricture, and Barrett esophagus. It is crucial to identify and characterize hiatal hernia and longitudinal stricture, which can result in a shortened esophagus. In such cases, it becomes necessary for the surgeon to incorporate an esophageal lengthening procedure prior to fundoplication; otherwise, poor surgical outcome is likely. Normal postfundoplication radiographic findings as well as postoperative complications (eg, tight wrap, perforation, abscess, complete or partial dehiscence, recurrent stricture, recurrent hernia, intrathoracic migration of the wrap) must also be recognized and clearly understood by the radiologist. Given the chronic nature and prevalence of symptomatic GERD and the increasing number of patients undergoing surgical intervention, it is imperative that the radiologist understand the pre- and postsurgical evaluation of affected patients.
 ...
PMID:Surgical approach to gastroesophageal reflux disease: what the radiologist needs to know. 1628 30

An important limitation of antireflux surgery is a 5%-10% failure rate. We investigated the correlation between various diaphragm stressors and failure of antireflux surgery. Forty-one study cases who underwent a reoperative antireflux operation from 1997 to 2001 and 50 control patients who had undergone a successful laparoscopic Nissen fundoplication during the same period without clinical or symptomatic evidence of failure were randomly selected for comparison. A retrospective analysis was conducted utilizing a standardized diaphragm stressor questionnaire, addressing the period between the primary and secondary operation. Stressors considered in the study included height, body mass index (BMI), postoperative gagging, vomiting, weight lifting (greater than 100 pounds), coughing, hiccuping, motion sickness, retching, belching, antidepressant use, smoking, preoperative grade of esophagitis, size of hiatal hernia, lower esophageal sphincter pressure, esophageal body pressures, and preoperative response to proton pump inhibitors. Of the potential stressors investigated, the following were significantly associated with surgical failure after adjusting for other variables through multivariate analysis: gagging (P = 0.005), belching (P = 0.02), and hernia size greater than 3 cm (P = 0.04; Table 1). Other potential risk factors show trends as obvious in Fig. 2. Vomiting was significant (P = 0.01) in the earlier models but lost significance when logistic regression was applied. Patients with postoperative gagging and an intraoperative hiatal hernia (greater than 3 cm) have a poorer outcome, whereas patients with postoperative belching have a better long-term outcome.
 ...
PMID:Assessment of diaphragmatic stressors as risk factors for symptomatic failure of laparoscopic nissen fundoplication. 1636 86

Most papers report excellent results of laparoscopic fundoplication but with relatively short follow-up. Only few studies have a follow-up longer than 5 years. We prospectively collected data of 399 consecutive patients with gastroesophageal reflux disease (GERD) or large paraesophageal/mixed hiatal hernia who underwent laparoscopic fundoplication between January 1992 and June 2005. Preoperative workup included symptoms questionnaire, videoesophagogram, upper endoscopy, manometry, and pH-metry. Postoperative clinical/functional studies were performed at 1, 6, 12 months, and thereafter every other year. Patients were divided into four groups: GERD with nonerosive esophagitis, erosive esophagitis, Barrett's esophagus, and large paraesophageal/mixed hiatal hernia. Surgical failures were considered as follows: (1) recurrence of GERD symptoms or abnormal 24-h pH monitoring; (2) recurrence of endoscopic esophagitis; (3) recurrence of hiatal hernia/slipped fundoplication on endoscopy/barium swallow; (4) postoperative onset of dysphagia; (5) postoperative onset of gas bloating. One hundred and forty-five patients (87 M:58 F) were operated between January 1992 and June 1999: 80 nonerosive esophagitis, 29 erosive esophagitis, 17 Barrett's esophagus, and 19 large paraesophageal/mixed hiatal hernias. At a median follow-up of 97 months, the success rate was 74% for surgery only and 86% for primary surgery and 'complementary' treatments (21 patients: 13 redo surgery and eight endoscopic dilations). Dysphagia and recurrence of reflux were the most frequent causes of failure for nonerosive esophagitis patients; recurrence of hernia was prevalent among patients with large paraesophageal/mixed hiatal hernia. Gas bloating (causing failure) was reported by nonerosive esophagitis patients only. At last follow-up, 115 patients were off 'proton-pump inhibitors'; 30 were still on medications (eight for causes unrelated to GERD). Conclusion confirms that laparoscopic fundoplication provides effective, long-term treatment of gastroesophageal reflux disease. Hernia recurrence and dysphagia are its weak points.
 ...
PMID:Long-term results (6-10 years) of laparoscopic fundoplication. 1761 38

A 6-month-old domestic shorthair female cat was presented with suspected diaphragmatic hernia (DH) that was later confirmed by thoracic radiography. The cat underwent exploratory celiotomy with a diaphragmatic rupture (DR) repair and recovered. Six days later, it was represented with vomiting and anorexia. Megaoesophagus (MO) and gastric dilatation were diagnosed by contrast radiography. A second celiotomy revealed no abnormalities and gastropexy was performed. Endoscopy demonstrated MO, oesophagitis and gastro-oesophageal reflux. MO persisted for several weeks and was an unexpected complication as no association between DR (or DH) and MO has never been described in the veterinary literature. The cat was treated medically with aggressive prokinetic and antacid therapy along with prolonged temporary oesophageal diversion (percutaneous endoscopic gastrostomy tube) with an excellent outcome.
 ...
PMID:Transient megaoesophagus and oesophagitis following diaphragmatic rupture repair in a cat. 1824 47


<< Previous 1 2 3 4 5 6 Next >>