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

Cirrhosis is a significant marker of adverse postoperative outcome. A large national database was analyzed for abdominal wall hernia repair outcomes in cirrhotic vs. non-cirrhotic patients. Data from cirrhotics and non-cirrhotics undergoing inpatient repair of abdominal wall hernias (excluding inguinal) from 1999 to 2004 were obtained from the University HealthSystem Consortium (UHC) database. Differences (P < 0.05) were determined using standard statistical methods. Inpatient hernia repair was performed in 30,836 non-cirrhotic (41.5% male) and 1,197 cirrhotic patients (62.7% male; P < 0.0001). Cirrhotics had a higher age distribution (P < 0.0001), no race differences (P = 0.64), underwent ICU admission more commonly (15.9% vs. 6%; P < 0.0001), had a longer LOS (5.4 vs. 3.7 days), and higher morbidity (16.5% vs. 13.8%; P = 0.008), and mortality (2.5% vs. 0.2%; P < 0.0001) compared to non-cirrhotics. Several comorbidities had a higher associated mortality in cirrhosis: functional impairment, congestive heart failure, renal failure, nutritional deficiencies, and peripheral vascular disease. The complications with the highest associated mortality in cirrhotics were aspiration pneumonia, pulmonary compromise, myocardial infarction, pneumonia, and metabolic derangements. Cirrhotics underwent emergent surgery more commonly than non-cirrhotics (58.9% vs. 29.5%; P < 0.0001), with longer LOS regardless of elective or emergent surgery. Although elective surgical morbidity in cirrhotics was no different from non-cirrhotics (15.6% vs. 13.5%; P = 0.18), emergent surgery morbidity was (17.3% vs. 14.5%; P = 0.04). While differences in elective surgical mortality in cirrhotics approached significance (0.6% vs. 0.1%; P = 0.06), mortality was 7-fold higher in emergencies (3.8% vs. 0.5%; P < 0.0001). Patients with cirrhosis carry a significant risk of adverse outcome after abdominal wall hernia repair compared to non-cirrhotics, particularly with emergent surgery. It may, however, be safer than previously thought. Ideally, patients with cirrhosis should undergo elective hernia repair after medical optimization.
Hernia 2005 Dec
PMID:Poor outcomes in cirrhosis-associated hernia repair: a nationwide cohort study of 32,033 patients. 1613 87

Continuous ambulatory peritoneal dialysis (CAPD) is a popular way of treatment of the patients with renal failure. There were 1365 patients on CAPD in Poland in the year 2001. Higher frequency of groin and abdominal hernias was reported in those patients. 10% of dialysed patients developed hernia in the first five years of the therapy. The main problems of hernia repair in the CAPD patients are: increased pressure in abdominal cavity caused by dialysate volume, higher risk of peritonitis, poor prognosis in the complicated cases temporarily or permanently converted to hemodialysis (HD) and the insufficiency of healing process. Complications accorded to hernia repair are the third most often reason of conversion to HD. Conducted studies on hernia repair did not lead to the introduction of the world standard. Authors propose to introduce an unified protocol to improve treatment results. Main guidelines of hernia treatment in CAPD patients are: 1) consultation of the surgeon cooperating with dialysis center in qualification to CAPD, and in the case of hernia symptoms in CAPD patients, 2) application of tension-free methods (PHS recommended), 3) administration of antibiotic prophylaxis, 4) application of local or epidural anesthesia, 5) no necessity of discontinuation of CAPD procedures.
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PMID:[Groin hernia in the patients receiving CAPD]. 1652 69

Peritoneal dialysis is becoming more and more common as a method of treating patients at the final stage of renal failure. In the year 2002 the number of patients treated with this method in Poland amounted to 1324. Studies have demonstrated that inguinal and abdominal hernias develop more frequently in chronic renal failure patients. The percentage of patients with hernia diagnosed within the first five years of dialysis is about 10%. Continuation of dialysis with the hernia condition left untreated may result in severe complications which are the third most frequent cause of converting treatment method into hemodialysis in PD patients. Currently in Poland there is no national standard in existence as to the management of hernias, and the only British standard from 1998 does not reflect the present expertise of either surgical treatment or dialysis methods. The aim of the current questionnaire based study investigating Polish peritoneal dialysis centers was to assess the treatment when hernia had been diagnosed in the PD patient. Of 49 dialysis centers in Poland, 39 do have protocols on managing the patient before and after the operation. A considerable diversity has been found as to surgical techniques used and the ways the patients are managed in hospital. Following the need expressed by 33 dialysis centers in Poland for some standard for relevant procedures, the authors formulated principles of modern hernia treatment in PD patients. Accordingly, the main principles include: 1) consulting a surgeon collaborating with the center before qualifying for peritoneal dialysis and when hernia symptoms have manifested; 2) Tension-free methods used in a treatment of choice (recommended by PHS); 3) Application of antibiotic prophylaxis (preferably first generation cephalosporin); 4) Induction of local or epidural anesthesia; 5) Peritoneal dialysis programme does not need to be discontinued but low volume dwells or preferably intermittent APD is recommended immediately after surgery.
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PMID:Management of inguinal hernia on peritoneal dialysis: an audit of current Polish practice and call for a standard. 1684 Dec 85

Familial hypomagnesemia with hypercalciuria and nephrocalcinosis is an autosomal recessive renal tubular disorder characterized by renal magnesium wasting, hypercalciuria, advanced nephrocalcinosis and progressive renal failure. Mutations in the paracellin-1 (CLDN16) gene have been defined as the underlying genetic defect. The tubular disorders and progression in renal failure are usually resistant to magnesium substitution and hydrochlorothiazide therapy, but hypomagnesemia may improve with advanced renal insufficiency. We present a patient with a homozygous truncating CLDN16 gene mutation (W237X) who had early onset of renal insufficiency despite early diagnosis at 2 months. He also had additional abnormalities including horseshoe kidney, neonatal teeth, atypical face, cardiac abnormalities including coarctation of the aorta associated with atrial and ventricular septal defects, umbilical hernia and hypertrichosis. To the best of our knowledge, this is the youngest case diagnosed as familial hypomagnesemia with hypercalciuria and nephrocalcinosis and the first case having such additional congenital abnormalities independent of the disease itself.
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PMID:Paracellin-1 gene mutation with multiple congenital abnormalities. 1692 49

We report a case of orthotopic heart transplantation in a 42-year-old man who had cardiomyopathy with severe biventricular heart failure, ascites, and large umbilical hernia. He successfully received an orthotopic heart transplantation. After heart transplantation, renal failure was noted. Ascites and renal failure were successfully managed with repeated paracentesis. His cardiac and abdominal symptoms subsided gradually following transplantation. His umbilical hernia was repaired 55 days after the heart transplantation because of strangulation. In this case study, we report a patient with ascites who was treated for postoperative renal failure with repeated paracentesis.
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PMID:Repeated paracentesis for treatment renal failure after heart transplantation in patient with ascites. 1733 52

Complete and isolated herniation of the urinary bladder is extremely rare, and the consecutive appearance of bilateral urethral obstruction and renal failure is even rarer. We report about a 73 year old male presenting with massive nausea and muscular weakness. On physical examination he showed a giant inguinal hernia with involvement of the entire bladder along with evidence of bilateral hydronephrosis. His serum creatinine and potassium levels were markedly elevated most likely leading to his presenting symptoms of azotemia (nausea) and hyperkalemia (weakness). After transscrotal drainage and decompression of the bladder, a transurethral catheter was inserted. After gaining full renal recovery, the hernia was repaired successfully performing the Lichtenstein procedure.
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PMID:[Subacute weakness of the lower limbs]. 1786 9

Bladder hernia is not a rare pathological condition, with a frequency between 0,3 and 3%. Massive bladder hernia is less frequent an very rarely ureterohydronephrosis with this pathology. We will present a case a renal failure secondary to inguinoscrotal bladder hernia with bilateral obstructive uropathy and an analyzed the clinical presentation, the diagnosis and the treatment for those hernias.
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PMID:[Bilateral ureterohydronephrosis secondary to massive vesical hernia]. 1851 94

The facio-oculo-acoustico-renal syndrome (FOAR) is a rare autosomal recessive syndrome characterized by the presence of dysmorphic facial features, ocular anomalies, sensorineural hearing loss, and proteinuria. Diaphragmatic hernia, exomphalos, absent or abnormal corpus callosum, and myopia, can also be part of the syndrome. The disorder is caused by mutations of the LRP2 gene located on chromosome 2q23.3-q31.1. We hereby report the case of a 56-year-old female patient with typical FOAR features. Molecular study of the LRP2 gene revealed the presence of a novel splice-site mutation. In addition to what was reported in FOAR syndrome, this patient had a megadolichocolon complicated by a volvulus and a late-onset renal failure which necessitated hemodyalisis and renal transplantation. Reporting aging patients with genetic syndromes will provide information about their special needs and lead to improvements in their follow-up.
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PMID:A 56-year-old female patient with facio-oculo-acoustico-renal syndrome (FOAR) syndrome. Report on the natural history and of a novel mutation. 1957 69

At present, the fetus is already considered a "patient" and as such, can develop diseases with fatal outcome in which the only therapeutic option can be fetal surgery. Currently, fetal surgery is limited almost exclusively to endoscopic surgery. Different techniques have gained clinical acceptance for improving the prognosis of various lethal fetal pathologies. Laser therapy for twin to twin transfusion syndrome and cord occlusion in monochorionic twins with selective intrauterine growth restriction are the procedures of choice for the management of monochorionic twins complications, and are associated with survival rates of up to 80-90% for at least one fetus. In fetuses with isolated congenital diaphragmatic hernia and severe pulmonary hypoplasia, fetal endoscopic tracheal occlusion has shown to improve the survival probabilities from 5% to 55% and from 1% to 33% in left and right congenital diaphragmatic hernia, respectively, and a decrease in the rate of pulmonary hypertension and neonatal morbidity. In selected cases with low urinary tract obstruction (megacystis) and without renal failure; fetal cystoscopy is a diagnostic method that excludes the possibility of urethral stenosis or atresia and may be used to ablate posterior urethral valves by laser, restoring urethral patency and potentially preserving respiratory and bladder function. In fetuses with pulmonary masses, either primary or due to airway obstruction, there is high risk of fetal death due to cardiac compression and contralateral pulmonary hypoplasia. In such cases fetal bronchoscopy can provide a successful therapeutic option to release airway obstruction.
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PMID:[Endocopic fetal surgery]. 2493 48

Inguinoscrotal bladder hernias are rare, occurring in 1-4% of all inguinal hernias. Massive inguinoscrotal bladder hernias, where >50% of the bladder is found in the hernia sac are extremely rare. Patients can suffer significant morbidity from such a hernia. These include sepsis, unilateral or bilateral ureteric obstruction, renal failure and strangulation with secondary ischaemia of the bladder wall and bladder rupture. Inguinoscrotal bladder hernias are most commonly diagnosed at the time of surgery. This may lead to significant complications for the patient, particularly if undetected during surgery.
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PMID:Massive inguinoscrotal bladder hernia. 2496 Jan 33


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