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

Three hundred fifty-seven groin hernia repairs were performed under local anesthesia using a long-lasting local anesthetic agent. An ilioinguinal, iliohypogastric, and twelfth intercostal nerve block was carried out initially, followed by regional infiltration of the agent, using a technic first described by Ponka [8] with several modifications. This technic can be employed suffessfully in the majority of groin hernia repairs. It requires careful attention to detail in the administration of preoperative sedation and analgesia and the use of sharp dissection only and greater gentleness in the handling of tissue. We have observed a significant reduction in postoperative discomfort and the virtual elimination of urinary retention, urinary sepsis, atelectasis, and phlebitis in these cases. All patients are fully ambulatory, without assistance immediately after surgery and the majority are discharged the same day or the following morning. This results in a marked reduction in the total cost of repairing a groin hernia.
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PMID:Change in the management of adult groin hernia. 41 25

Our experience in the surgical management of hydatid disease of the liver in 212 patients over the past eighteen years is reviewed. The most frequent postoperative complications and mortality rates of elective and emergency procedures are presented, and the more frequently utilized operative technics are described. In the great majority of patients conservatism was the rule in excision of solitary or multiple cysts. It is important to establish whether or not hepatic cysts communicate with the biliary tree. In these cases, enteroanastomoses (such as cystjejunostomy or cystgastrostomy) may be utilized depending on the position of the cyst. Any associated biliary disease (such as lithiasis or fibrosis) should be taken care of at the same time. External cystic drainage (marsupialization) is contraindicated because of the high incidence of chronic external biliary fistula, secondary hemorrhage, sepsis, and postlaparotomy hernia. In those patients in whom the cyst has penetrated the diaphragm and communicates with the lung, treatment should be carried out in one stage whenever possible.
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PMID:Hydatid disease of the liver. 63 7

A retrospective analysis was undertaken of the records of 107 patients with Crohn's disease of the colon or with ulcerative colitis who underwent 162 operations under steroid cover. The study revealed no correlation between steroid dosage and postoperative morbidity or mortality. The incidence of wound dehiscence and incisional hernia compared favourably with the reports of other unselected series of similar patients. Contamination did significantly influence results. Septic complications were more frequent when the operative field was contaminated and both delayed wound healing and mortality were related to this sepsis. A ;clean and dirty' technique was effective in controlling contamination during elective bowel division but preoperative bowel perforation and accidental entry into the lumen of the bowel during dissection were potentially avoidable sources of contamination. Primary healing of the perineal wound after proctocolectomy was seldom achieved in contaminated patients where a drain tube was brought out through the main perineal incision. When perineal sinuses or fistulae followed a proctocolectomy, patients with Crohn's disease had a significantly slower rate of healing than did patients with ulcerative colitis. However, there was no difference in the healing of abdominal wounds in relation to the primary pathology. Even abdominal incisions which were used on more than one occasion healed as well as those which were used for the first time. A prophylactic antibiotic regime of either ampicillin or tetracycline offered little protection against postoperative sepsis. The organisms which caused such infections were often insensitive to the two antibiotics.
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PMID:Factors which influenced postoperative complications in patients with ulcerative colitis or Crohn's disease of the colon on corticosteroids. 68 Jun 5

Between 1968 and 1973, 12 patients with a chronic afferent loop syndrome were treated at the University Surgical Hospital in Munich (6 from own hospital and 6 B II resected patients from external hospitals). 11 of them had to undergo reoperation (1 patient refused). X-ray and gastroscopy confirmed the diagnosis of chronic afferent loop syndrome type I in all 12 cases. The obstruction was caused by: adhesion and kinking of the loop (7 cases), too long and mobile loops (6 cases) incorrect anastomosis (3 cases), torsion and stenosis in the mesocolonic slit (2 cases), internal hernia (1 case). 8 patients showed good operative results, in 2 patients symptoms still persist; 1 patient died of sepsis postoperatively.
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PMID:[The chronic afferent loop syndrome (author's transl)]. 80 46

Extracorporeal membrane oxygenation (ECMO) is effective for newborns with pulmonary failure unresponsive to conventional therapy. However, ECMO for the older child and adult has been controversial and not widely utilized. Over 4 years, 24 patients (aged 4 months to 16 years; 11 boys, 13 girls) underwent venoarterial ECMO (duration, 7 to 19 days) for respiratory failure. The diagnoses were: viral pneumonia (7), hydrocarbon aspiration (6), sepsis with adult respiratory distress syndrome (ARDS) (2), bacterial pneumonitis (2), tracheal stenosis (1), bilateral pulmonary contusion (1), diaphragmatic hernia with ARDS (1), ketoacidosis with ARDS (1), pulmonary artery injection of hydrocarbon (1), drowning (1), and epiglottis with barotrauma (1). Pre-ECMO blood gas ranges (and means) were PO2 18 to 65 (46), and PCO2 47 to 112 (65). Nineteen patients received dopamine, dobutamine, or other inotrope for associated cardiac and/or renal failure. Cannulation for ECMO was through neck or groin vessels in 17, and sternotomy in 7. ECMO flow rates were 150 to 250 mL/kg/min, to maintain PO2 greater than 100 and PCO2 less than 40. Nine patients (41%) survived ECMO, with eight long-term survivors, (4 hydrocarbon aspiration or injection, 1 pulmonary contusion, 1 viral pneumonia, 1 ARDS, 1 barotrauma), three of whom have mild neurological deficit. All patients with sternotomy, and 8 of 15 with neck and/or groin cannulation, required 1 to 5 explorations for hemorrhage while on ECMO. All survivors had primarily pulmonary failure; patients with combinations of pulmonary, cardiac, and renal failure did not survive. ECMO can be life-saving in the child with isolated pulmonary failure, but its efficacy in patients with multiorgan failure is uncertain.
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PMID:Prolonged extracorporeal support for nonneonatal respiratory failure. 140 44

We report our experience from May 1985 to January 1991 with surgical complications and procedures performed in neonates on extracorporeal membrane oxygenation (ECMO) (218 venoarterial and 7 venovenous bypass). Eleven children older than 1 month were excluded. Total complications were 96 in 67 patients and included: bleeding (37), problems with initial cannula placement (17), thrombus formation (15), hemothorax, pneumothorax, or effusions (11), mechanical problems (11), and miscellaneous (5). Forty-eight procedures were performed in 37 patients while on ECMO. These were recannulation or reposition of cannulas (14), tube thoracostomy (11), cardiac surgery (6), cardiac catheterization (4), repair of congenital diaphragmatic hernia (5), thoracotomy (4), and others. Twenty-eight complications occurred in 15 of the 27 patients who died. Mortality rate was 12% for the entire group. Primary causes of death were hypoplastic lung (11), cardiac (8), sepsis (4), intraventricular hemorrhage (2), and pulmonary hypertension (2). No deaths were due solely to complications except for the two patients with intraventricular hemorrhage. Mortality in neonates who had complications while on ECMO was significantly higher (P less than .005) than in patients without complications. Hemorrhagic and thoracic complications were associated with higher mortality (P less than .001). Mortality was not affected by mechanical problems, thrombus formation, or catheter-related problems. While on ECMO cardiac defects, diaphragmatic hernia, lobar emphysema, and other conditions can be safely corrected. The use of echocardiography to position the cannulas, better control of coagulation factors and improvement in equipment may ultimately decrease complications.
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PMID:Surgical complications and procedures in neonates on extracorporeal membrane oxygenation. 140 45

One hundred ten infants with congenital diaphragmatic hernia (CDH) developed life-threatening respiratory distress in the first 6 hours of life. Associated anomalies were present in 33%. Twenty-eight of 65 infants (43%) treated before 1987 (pre-extracorporeal membrane oxygenation [ECMO] era) survived after immediate CDH repair, and mechanical ventilation with or without pharmacologic support. Only two of 16 (12.5%) infants requiring a prosthetic diaphragmatic patch survived. Since 1987, 31 of 46 (67.4%) infants with birth weight, gestational age, and severity of illness similar to the pre-1987 group survived. All patients were immediately intubated and ventilated. Seven (four with lethal chromosomal anomalies) infants died before treatment, and 30 stabilized (partial pressure of carbon dioxide [PCO2] < 50; partial pressure of oxygen [PO2] > 100; pH > 7.3) and underwent delayed CDH repair at 5 to 72 hours. Fifteen did well on conventional support and survived. Fifteen infants deteriorated after operation: 11 were placed on ECMO with eight survivors, and four infants were not considered ECMO candidates. Nine babies failed to stabilize initially and were placed on ECMO before CDH repair (alveolar-arterial gradient > 600 and oxygenation index > 40), and seven survived. The overall survival rate was 80% at 3 months in this ECMO-treated group. Early mortality was due to inability to wean from ECMO (one), intracranial hemorrhage (one), liver injury (one), and pulmonary hypoplasia (one). Nine of 11 babies requiring a prosthetic patch in the post-1987 ECMO group survived (81.8%). There were three late post-ECMO deaths (3 to 18 months) of right heart failure (two) and sepsis (one). Symptomatic gastroesophageal reflux occurred in nine cases, six requiring a fundoplication in the bypass babies. Recurrent diaphragmatic hernia occurred in nine cases (five ECMO). The overall survival rate was significantly improved in the delayed repair/ECMO group (67% versus 43%; p < 0.05) and was most noticeable in infants requiring a prosthetic diaphragm (81.2% versus 12.5%; p < 0.005). These data indicate that early stabilization, delayed repair, and ECMO improve survival in high-risk CDH. Early deaths are related to pulmonary hypertension and can be reversed by ECMO.
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PMID:Delayed surgical repair and ECMO improves survival in congenital diaphragmatic hernia. 141 95

We report on 50 term and near-term neonates (birth weight greater than 1800 g, gestational age greater than 33 weeks) with severe persistent pulmonary hypertension of the newborn (PPHN), referred to us from January 1987 to July 1991 after failure of maximum conventional treatment. All infants had paO2 less than 45 mm Hg when ventilated with peak inspiratory pressure greater than 38 cm H2O and FiO2 = 1.0, hence meeting entry criteria for extracorporeal membrane oxygenation (ECMO). High frequency oscillatory ventilation (HFOV) was tried in all patients. If sufficient oxygenation could not be achieved (paO2 less than 40 mm Hg for at least 2 h), ECMO therapy was begun, which was the case in 25 children. Neonates responding to HFOV (n = 25) were of a slightly younger gestational age (37.0 weeks vs 38.8 weeks, P less than 0.05), had higher Apgar scores and were less hypoxaemic before HFOV (paO2 36.6 mm Hg vs 28.8 mm Hg, P less than 0.01); during HFOV there was a significant rise in paO2 (greater than 150 mm Hg; P less than 0.001) and a fall in pCO2 to 21.6 mm Hg (P less than 0.001). Due to air leaks, which was the main complication of HFOV (52%), ECMO therapy had to be begun in two additional infants after an initial positive effect. HFOV tended to be successful in cases of primary PPHN, meconium aspiration and sepsis, but not in infants with lung hypoplasia as a result of diaphragmatic hernia or other reasons. Success or failure of HFOV could not be reliably predicted by any parameter.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:High frequency oscillatory ventilation and extracorporeal membrane oxygenation in severe persistent pulmonary hypertension of the newborn. 142 1

With experience of six already known techniques, the authors have developed a personal procedure combining three main principles: 1) large and direct exposure of the preperitoneal space, 2) the mesh, supple but not soft, needing no fixation, 3) outline of this mesh adapted to the concave shape of the pelvic wall, and avoiding the risk of a ventral hernia. The original points of this technique are the following: approach along the lateral border of the rectus muscle through its sheath, the initial exposure of the iliopsoas muscle and retropubic space, and the cutting of the mesh extending far beyond the borders of the inguinal and femoral orifices, with a flap reinforcing the posterior aspect of the rectus muscle. One hundred and two consecutive patients (173 hernias, 48 recurrences) were operated upon, and all but two were followed for a mean period of 36.8 months. Morbidity was low, with no prosthesis infection, and there was no recurrence or incisional hernia. The authors emphasize the simplicity and the rapidity of this technique, without advocating it as a routine operation, since it carries, like all prosthetic techniques, the potential for sepsis and preperitoneal fibrosis.
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PMID:[A direct approach and a crease-resistant prosthesis: two simplifications of subperitoneal hernioplasty]. 145 96

A case of right-sided diaphragmatic hernia following group B streptococcal pneumonia and sepsis is reported herein. The clinical course was characteristic. The position of the right hemidiaphragm was initially normal. After an antecedent group B streptococcal infection, an abnormal shadow indicating either pneumonia or a pleural effusion on the chest x-ray was recognized and an elevation of the bowel and liver into the right hemithorax gradually appeared. Repair of the hernia was indicated and the postoperative result was excellent. The relationship between a delayed-onset diaphragmatic hernia and a group B streptococcal infection is still unknown. Increased intrathoracic pressure caused by mechanical ventilation coupled with an abnormal lung compliance due to inflammation may have resulted in the delayed herniation. Among various methods for diagnosis applied, chest x-ray and ultrasonography were noninvasive and useful.
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PMID:Right-sided diaphragmatic hernia following group B streptococcal pneumonia and sepsis. 150 Oct 42


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