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)

Left ventricular assistance with a number of different devices has been used to successfully bridge patients to cardiac transplantation. Surgical complications or complications related to the device itself, however, may preclude transplantation or lead to death. We report our recent experience with the Thermo Cardiosystems model 14 "HeartMate" left ventricular assist device in 3 patients. The device was implanted for 15 to 95 days. Complications included mediastinitis and peritonitis associated with the device in place before transplantation, and colonic perforation, and a late diaphragmatic hernia after transplantation. Despite these and other minor complications, all 3 patients underwent successful cardiac transplantation. Mechanical support for the right ventricle was not necessary. The Thermo Cardiosystems left ventricular assist device provided excellent support in a range of physiological conditions with no mechanical malfunction despite the surgical complications.
 ...
PMID:Surgical complications in bridging to transplantation: the Thermo Cardiosystems LVAD. 141 63

To determine the incidence, the mortality, the risk factors and the most appropriate method for treatment of sternal infections, 9,742 charts were reviewed retrospectively of patients having undergone a sternotomy for cardiac surgery at the Montreal Heart Institute. One hundred and eleven sternal infections (1.1%) were identified: 55 (0.57%) superficial, 56 (0.57%) profound (mediastinitis). The treatment for these profound infections was either debridement, open or closed with drainage irrigation, pectoral flap closure-repair, or epiplooplasty closure. The risk factors for those patients experiencing profound infections were diabetes, obesity, length of the surgical intervention, the time spent in the operating room, and the duration of endotracheal intubation. Eleven of the 111 patients died. The average length of hospitalization were similar for those patients treated by pectoral flap repair and by the epiplooplasty closure. All patients (100%) treated by the epiplooplasty closure developed an epigastric hernia. Six cases of recurrent infection were observed in the group treated by debridement. The average hospital stay was shortened for those patients benefiting from the pectoral flap and epiplooplasty closures. A high incidence of mortality is associated with profound sternal infection. The methods of treatment are various. We recommend as treatment of choice, the pectoral flap closure because there is relatively low risks with this procedure, little to no recurrence of infection, a shorter hospital stay and this procedure does not provoke epigastric hernia.
 ...
PMID:[Post-sternotomy mediastinitis: strategy of treatment]. 178 19

Minimally invasive surgery has gained popularity in the last decade and its applications to plastic surgery are expanding. Pedicled omental flaps are used for the reconstruction of chest wall defects following debridement of sternal infections and mediastinitis. The main advantages of using an omental flap are its large size and bulk to fill large 3-dimensional dead spaces, long pedicle, and rich vascular and lymphatic networks. Recently, laparoscopic techniques have been described for harvesting omental flaps. Over the last 5 years in our institution, 9 laparoscopic omental flap harvests were performed. Seven were used in the reconstruction of complicated chest wall defects, sternal infections, mediastinal abscesses, and mediastinitis following cardiac surgery. Two were used to repair intrathoracic viscera. Prior abdominal surgery was not a contraindication to the laparoscopic harvest. In 1 patient, the omental transfer was converted to a free flap due to the detachment of the pedicle, and in 1 patient the omental harvest was converted to open technique due to technical difficulty due to severe abdominal adhesions. None of the patients had major intraabdominal complications postoperatively. One patient had a small transdiaphragmatic hernia treated by laparoscopic techniques. The use of laparoscopy techniques facilitated the harvesting of the omentum, making it ideal in the treatment of complicated patients with multiple comorbidities. With these techniques, pedicled omental flaps will be a reasonable treatment option for chest wall reconstruction.
 ...
PMID:Laparoscopically harvested omental flap for chest wall and intrathoracic reconstruction. 1548 5

Poststernotomy mediastinitis carries significant morbidity and mortality. Aggressive wound debridement combined with a pedicled omental flap, with or without a pedicled muscle flap, has gained acceptance in the management of difficult sternal wound infections. Two cases of poststernotomy mediastinitis and sternal wound reconstruction with a pedicled omental flap were complicated by a large anterior diaphragmatic hernia containing the large bowel.
 ...
PMID:Sternotomy reconstruction with omentum followed by large diaphragmatic hernia. 1643 4

We have applied omental transfer in cases of deep sternal wound infection (DSWI) that occurred after the right gastroepiploic artery was used as a coronary artery bypass graft. Study subjects were 7 patients (mean age was 66 years) who underwent coronary artery bypass grafting with the right gastroepiploic artery during the period January 1990-March 2004, then suffered DSWI and underwent single-stage treatment consisting of debridement and omental transfer 33 days on average (range 12-93 days) after the primary surgery. Patients were followed-up, and the following data were collected in retrospect: clinical presentation and in-hospital and long-term results. Three of the 7 patients underwent omental transfer based on the left gastroepiploic artery alone, 3 underwent omental transfer based on blood supply from a branch of the right gastroepiploic artery, and 1 underwent omental transfer based on blood supply from both branches. The hospital mortality rate was 14% (1 of 7 patients); death was caused by recurrent mediastinitis. Postoperative hospitalization was 47 days (range 21-83 days). Two patients died of cardiac failure, and 1 patient suffered abdominal wall hernia during the follow-up period. Even after harvesting of the right gastroepiploic artery, omental transfer was effective for the treatment of DSWI.
 ...
PMID:Omental transfer for deep sternal wound infection after coronary artery bypass grafting with the right gastroepiploic artery. 1767 Apr 58

Mis-swallowing of a foreign body in the esophagus coexisting with sliding hernia might be misdiagnosed as esophageal perforation with mediastinal abscess. We report an 89-year-old woman, bedridden for a long period in a nursing home after a previous cerebrovascular accident, who was sent to our emergency department in a state of sepsis because she had swallowed a radio-opaque partial denture. The retention of the denture as an esophageal foreign body was complicated with mediastinitis and bilateral pleural effusion. The inability of the patient to give a reliable clinical history delayed the diagnosis. This report highlights the difficulty in precisely locating a partial denture because of conflicting radiologic findings and the coexistence of esophageal sliding hernia, all of which led to a misdiagnosis of possible esophageal perforation. A right posterolateral thoracotomy with gastrostomy was performed to remove the lower esophageal foreign body after esophagoscopy failed. The surgical finding of a coincidental sliding esophageal hiatal hernia correlated well with the clinical presentation. Managing such a complicated esophageal foreign body in this elderly patient was challenging.
 ...
PMID:Denture mis-swallowing in the sliding esophageal hiatal hernia mimics esophageal perforation. 1867 51

We describe a rare complication and the treating experience of it after pedicled omental grafting for mediastinitis. The patient was diagnosed as an acute mediastinitis soon after the total arch replacement was performed. A two-staged strategy to treat postoperative mediastinitis was scheduled, i.e., the setting up of a vacuum-assisted closure system until the improvement of inflammation followed by wound closure with pedicled omental grafting. The treatment for acute mediastinitis was successful and the patient followed a favorable postoperative course. During the follow-up, chest X-ray film suggested the gradual enlargement of mediastinum and CT showed the herniation of transverse colon into mediastinum. Surgical correction for the hernia was scheduled and performed successfully by the laparoscopic procedure to prevent a possible cardiac and pulmonary dysfunction.
 ...
PMID:Herniation of transverse colon into mediastinum after pedicled omental grafting for mediastinitis: report of a case. 2409 37

Intrapericardial diaphragmatic hernias are reported very rarely. Those of congenital origin are most often diagnosed in neonates, and those caused by indirect blunt trauma occur chiefly in adults. The latter type can be asymptomatic; however, the results of a computed tomographic scan can yield a definitive diagnosis. Once discovered, these hernias should be corrected to avoid severe sequelae such as bowel strangulation and necrosis, peritonitis, mediastinitis, and cardiac tamponade. We report the case of a 78-year-old woman who presented for elective ascending aortic aneurysm repair. Computed tomographic angiograms incidentally revealed a large intrapericardial diaphragmatic hernia, which had probably developed years earlier, after a traffic accident. The patient underwent a median sternotomy and repair of the intrapericardial diaphragmatic hernia with use of a bovine pericardial patch, followed by ascending aortic and hemiarch repair, aortic valve repair, and aorto-right coronary artery bypass grafting. We discuss the details of these procedures and alternative treatment options. To our knowledge, this is the first report of concomitant aortic surgery and repair of a trauma-induced intrapericardial diaphragmatic hernia in an adult.
 ...
PMID:Repair of Intrapericardial Diaphragmatic Hernia during Aortic Surgery in a 78-Year-Old Woman. 2846 5