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

Cutis laxa is a condition characterized by redundant, pendulous, and inelastic skin. We identified a patient with recessive inheritance of a missense mutation (169G-->A; E57K) in the Fibulin-4 gene. She had multiple bone fractures at birth and was diagnosed with cutis laxa, vascular tortuosity, ascending aortic aneurysm, developmental emphysema, inguinal and diaphragmatic hernia, joint laxity, and pectus excavatum by age 2 years. Her skin showed markedly underdeveloped elastic fibers, and the extracellular matrix laid down by her skin fibroblasts contained dramatically reduced amounts of fibulin-4. We conclude that fibulin-4 is necessary for elastic fiber formation and connective tissue development.
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PMID:Fibulin-4: a novel gene for an autosomal recessive cutis laxa syndrome. 1668 58

Patients with complicated diverticulitis rarely present with extraperitoneal manifestations but the manifestation of subcutaneous emphysema appears even more seldom. We present the case of a patient with a history of diabetes and immunosuppression, who was admitted with sepsis in association with cellulitis and subcutaneous emphysema of the left groin. The absence of peritonism due to corticosteroid treatment, a history of a recent fall with an ilio- and ischio-pubic fracture and subcutaneous emphysema led to a delay in the diagnosis. The final diagnosis was a perforated diverticulitis in a patent inguinal canal, which was only revealed after surgery. The various complications of diverticulitis, including extraperitoneal manifestations, and associated microorganisms implicated in cellulitis and subcutaneous emphysema are briefly reviewed.
Hernia 2007 Jun
PMID:Subcutaneous emphysema: a rare manifestation of a perforated diverticulitis in a patent inguinal canal. 1713 7

During the past 5000 years, ancient nomenclature and dogmas regarding the etiology of protrusions have accumulated. Whereas, in the abdomen, the Latin "hernia" supplanted Greek, it, based on content, persists in the pelvis as cystocele, rectocele, etc. Russell (Lancet 1:1519-1523, 1902) championed the congenital saccular theory of herniae, denying they could ever be acquired pathologically. Barring technical error, removal of the sac would cure. Despite dissent in the 1920s by Harrison, Keith, and Andrews, Russell's concepts held late into the twentieth century. We now know that pathology - systemic connective tissue disease - plays an important role in adult herniation. Tensionless prosthetic repair is usually required since the healing of damaged musculo-aponeurotic structures in abdomen or pelvis is impaired. Laparoscopists have declared sliding extraperitoneal prolapse of sacless kidney, ureter, bladder, and fat pad to be herniae. Similar vaginal protrusions should be denoted likewise. It is time gynecologists and herniologists join in the effort to develop antidotes for combating this pernicious co-morbidity which has been shown also to cause aneurysms, diverticulosis coli, skin changes, and emphysema. Prophylaxis should include exercise and going without cigarettes.
Hernia 2007 Aug
PMID:Archaic terms and dogmas impeding care of abdominal and pelvic herniation. 1750 28

Injury prevention strategies for child bicyclists have focused on helmet use to prevent head trauma. Handlebars are another source of injury. A retrospective review from 2005 identified 385 admissions to a Level 1 pediatric trauma center of which 23 (5.9%) were pedal cyclists. Four cases (<1.0%) of handlebar injuries were identified. Three children (two bicyclists, one riding a scooter) sustained handlebar impact to the neck. All children with neck injuries had subcutaneous emphysema. Two of the children had pneumomediastinum, which after work-up was managed nonoperatively. One child had a tracheal injury requiring operative intervention. Another child was struck in the upper abdomen resulting in a traumatic abdominal wall hernia requiring emergent exploration and hernia repair. Discordance exists between the apparently minor circumstances of handlebar trauma and the severity of injury sustained by bicyclists. Recognizing the mechanism of handlebar-related injuries and maintaining a high index of suspicion for visceral injuries aids in the diagnosis. The incidence of these injuries is underestimated due to insufficient documentation of the circumstances of injury events and a lack of applicable E-codes specific for handlebar injury.
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PMID:Handlebar injuries in children: should we raise the bar of suspicion? 1787 90

The aim of this study was to investigate the relative accuracy of megavoltage photon-beam dose calculations employing either 5 bulk densities or independent voxel densities determined by calibration of the CT Houndsfield number. Full-resolution CT and bulk density treatment plans were generated for 70 lung or esophageal cancer tumors (66 cases) using a commercial treatment planning system with an adaptive convolution dose calculation algorithm (Pinnacle3, Philips Medicals Systems). Bulk densities were applied to segmented regions. Individual and population average densities were compared to the full-resolution plan for each case. Monitor units were kept constant and no normalizations were employed. Dose volume histograms (DVH) and dose difference distributions were examined for all cases. The average densities of the segmented air, lung, fat, soft tissue, and bone for the entire set were found to be 0.14, 0.26, 0.89, 1.02, and 1.12 g/cc, respectively. In all cases, the normal tissue DVH agreed to better than 2% in dose. In 62 of 70 target DVHs, agreement to better than 3% in dose was observed. Six cases demonstrated emphysema, one with bullous formations and one with a hiatus hernia having a large volume of gas. They required the additional assignment of density to the emphysemic lung and inflammatory changes to the lung, the regions of collapsed lung, the bullous formations, and the hernia gas. Bulk tissue density dose calculation provides an accurate method of heterogeneous dose calculation. However, patients with advanced emphysema may require high-resolution CT studies for accurate treatment planning.
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PMID:Accurate heterogeneous dose calculation for lung cancer patients without high-resolution CT densities. 1945 88

We experienced an extremely rare complication during performance of laparoscopic totally extraperitoneal (TEP) inguinal hernia repair for a 57-year-old healthy man. About 50 minutes after CO(2) insufflation, the patient developed tachycardia, hypoxemia, hypercapnia and an increased airway pressure. Right pneumothorax with subcutaneous emphysema was recognized on the emergency chest X-ray and this was successfully treated by chest tube insertion. Anesthesiologists should be aware of the possible occurrence of pneumothorax during laparoscopic TEP hernia repair.
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PMID:Pneumothorax during laparoscopic totally extraperitoneal inguinal hernia repair -A case report-. 2053 60

Injury to the right diaphragm is sometimes missed in the acute stage and is detected only when the rupture becomes more extensive, a diaphragmatic hernia develops, and dyspnea ensues. We report a case in which spontaneous right pneumothorax developed 46 months after blunt trauma due to a fall. Air had leaked into the right pleural cavity, passed through the injured right diaphragm, and entered the abdominal cavity; the patient presented with intraperitoneal emphysema.
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PMID:Late diaphragmatic laceration detected as a result of spontaneous pneumothorax. 2131 79

Unilateral hyperlucent hemithorax is a common pediatric chest radiographic finding that may also be seen at computed tomography. It may result from congenital or acquired conditions involving the pulmonary parenchyma, airway, pulmonary vasculature, pleural space, and chest wall, as well as from technical factors such as patient rotation. Unilateral hyperlucent hemithorax has a broad differential diagnosis that includes unilateral emphysematous or bullous disease, pneumatocele, foreign body aspiration, Swyer-James syndrome, congenital lobar emphysema, endobronchial mass, unilateral pulmonary agenesis, proximal interruption of the pulmonary artery, scimitar syndrome, diaphragmatic hernia, and Poland syndrome. Although certain causes of unilateral hyperlucent hemithorax are clinically significant and potentially life threatening, others are of minimal or no clinical significance. When evaluating a patient with this finding, it is important to establish whether the apparent unilateral hyperlucent hemithorax is truly too lucent (hypoattenuating) or if the contralateral hemithorax is too opaque (hyperattenuating). It is imperative that radiologists be aware of the various causes of unilateral hyperlucent hemithorax so that they may diagnose the underlying condition and appropriately guide patient management.
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PMID:Expanding upon the unilateral hyperlucent hemithorax in children. 2157 53

The Nyhus-Wantz Lectureship honors two giants who represent the few who formed a new surgical specialty: herniology. My topics are etiology, herniosis, diverticulosis coli, and cancer. Hippocrates blamed wear and tear for herniation. Russell's (Lancet 1:1519-1523, 1902) explanation was congenital peritoneal "buds" extending down to the pelvis. Harrison (Arch Surg 4:680-689, 1922) attributed herniae to transversalis fascial degradation. Keith (Lancet 2(17):1398-1399, 1906) concluded that pathology was involved, even though Russell (Lancet 1:1519-1523, 1902) had denied it. Nevertheless, the congenital theory prevailed. According to McVay (Christopher's textbook of surgery, W.B. Saunders, Philadelphia, 1960, p. 159), defects arise in normal musculo-aponeurotic structures. Research showed that atrophy was caused by damaged fibroblasts producing less collagen, which was abnormal (having a reduced I/III ratio). The disease was systemic, later named herniosis. Nicotine addiction increased the incidence of herniation by an inflammatory process named metastatic emphysema. In 1948, Saint's Triad, an aggregation of hiatus hernia (later, any primary hernia), gallstones, and diverticulosis coli, was introduced. This association occurred eight times more often than expected, with herniosis appearing to be its cause, abetted by high blood cholesterol causing gallstones. In 2006, Krones et al. (Int J Colorectal Dis 21:18-24, 2006) provided evidence that colon cancer is accompanied by a reduction in diverticula. Klinge et al. (Hernia 8(4):300-301, 2004) showed that these entities require different extracellular matrices (ECMs). Ghajar and Bissell (Histochem Cell Biol 130:1105-1118, 2008) pointed out that the ECM, which comprises 80% of the breast, influences its epithelial genetic expression, likewise with other organs (kidney, skin, lung, colon, and ovaries). Recently, a fundamental change in our understanding of cancer growth and metastasis has taken place. Whereas the degradation of connective tissue was thought to encourage invasion, eliciting concern for the herniated, now, investigators report the reverse, a reactive vascularized stroma resembling wound healing with an increase in fibroblasts and collagen I. Words such as desmoplasia, fibrosis, and stiffening abound. In conclusion, degradation of the ECM may be why herniosis appears to be hostile to the development of cancer throughout the body. Studies are needed of patients with and without a history of hernia to determine their incidence of cancer. Data from smokers should be separated, since they carry their own high risk of malignancy.
Hernia 2011 Oct
PMID:The Nyhus-Wantz lectureship: etiology, herniosis, diverticulosis coli, and cancer. 2159 Apr 41

Repair of traumatic abdominal wall hernia (TAWH) has been reported to be necessary. Reported here is one case of TAWH without repair. A 27-year-old man was accidentally sandwiched between a rock and a truck and admitted to our emergency department. There was a swelling of 10 cm in the right upper quadrant of the abdomen. The enhanced computed tomographic scan demonstrated a large abdominal wall muscular defect, transverse colon protrusion, and the presence of subcutaneous emphysema at the site. Based on these findings, lacerated transverse colon entrapped in TAWH was diagnosed. The patient underwent emergency laparotomy for laceration of the transverse colon, duodenum and pancreas, and open book fracture of the pelvis. Repair of the hernia was not performed because of the possibility of abscess formation by stool contamination. However, the hernia disappeared and the patient is doing well without recurrence of hernia 16 months after injury.
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PMID:Traumatic Abdominal Wall Hernia: A Case Report of High-Energy Type without Surgical Repair. 2208 11


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