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

Anderson Area Medical Center physicians have been provided disease and procedure specific profiles of their practice experience for more than five years. For four years, physicians were provided reporting, in a variety of formats, detailing their clinical outcomes and consumption of hospital resources in treating patients with acute myocardial infarction (AMI), pneumonia, cholecystectomy, stroke, congestive heart failure (CHF), and total hip replacement. For the past eighteen months physicians have been provided a uniform format of monthly physician-specific reporting for stroke, AMI, pneumonia, diabetes, CHF, cholecystectomy, total hip replacement, newborn delivery, angina, and hernia repair. Using only a modest PC platform with database, word processing, and graphics programs operating in a DOS environment, an effective disease/procedure reporting program is provided to medical staff with 3 person-days of effort per month.
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PMID:Lowering physician hospital resource consumption using low-cost low-technology computing. 856 69

We have used an oesophageal Doppler to measure aortic blood flow velocity before, during and after induction of carbon dioxide pneumoperitoneum in 10 consecutive patients, mean age 58 yr, undergoing laparoscopic hernia repair. Derived values for stroke distance, minute distance and systemic vascular resistance showed considerable interpatient variation indicating unpredictable haemodynamic responses. Five minutes after insufflation of the abdomen there was a significant increase in mean arterial pressure from 82.5 to 103.6 mm Hg (P < 0.05) but both stroke distance and minute distance decreased significantly (mean 12.0 (SEM 1.4) cm to 9.0 (0.7) cm, P < 0.05; and 747.5 (82) cm min-1 to 596 (49) cm min-1, P < 0.05; respectively) indicating a significant decrease in cardiac output. There was a corresponding increase in the index of systemic vascular resistance from 1092 (747) to 2079 (400) (P < 0.05) which persisted after deflation of the abdomen. Oesophageal Doppler can provide continuous online haemodynamic data with a rapid response to acute changes and may have a role in non-invasive haemodynamic monitoring during laparoscopic procedures in older patients with cardiovascular disease.
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PMID:Assessment of cardiovascular changes during laparoscopic hernia repair using oesophageal Doppler. 917 64

From a clinical point of view, vesical hernia is an uncommon condition. Occurrence is more frequent in male. In most cases diagnosis follows surgical repair of inguinal hernia, to which it may be associated (1-10% depending on the series). Unless complications arise, it evolves asymptomatically or reveals its presence by the distinctive two-stroke miction. Although infrequent, the most significant complications are incarcerations and strangulation with secondary necrosis of the vesical wall. Diagnosis is confirmed by radiological techniques: intravenous urography (IVU), retrograde cystography or computerised axial tomography (CAT). Treatment is always surgical. This paper presents one case of massive vesical hernia and a review of the relative literature.
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PMID:[A giant bladder hernia. Apropos a case]. 926 21

Twenty-seven patients underwent consecutive elective laparoscopic repair of paraesophageal hiatal hernia between October 1992 and June 1997. There were 24 females and 3 males. The average age was 68 years (range, 46-86) and average weight was 173 pounds (range, 122-243 lb.). Presenting symptoms were: postprandial epigastric pain or pressure in 19 patients, postprandial dyspnea in 7 patients, anemia in 5 patients, postprandial vomiting of food in 5 patients, and 1 patient had postprandial palpitation. Heartburn was present in 9 patients. Five patients had a history of symptoms of intermittent volvulus. History of hiatal hernia was present in 19 patients ranging from 6 months to 38 years in duration. The operative procedure included a laparoscopic reduction of the herniated stomach, excision of the hernia sac, and closure of the diaphragmatic defect with placement of mesh graft. Anterior gastropexy was performed on all patients except two who had a Nissen fundoplication due to severe reflux symptoms. Seven patients had laparoscopic cholecystectomy at the same time and one patient had an excision of a small benign gastric leiomyoma of the fundus. The average operative time was 2:54 hours (range, 1:35-4:05 hrs.). The average hospital stay was 3.8 days (range, 2-8 days). One patient had a postoperative stroke and recovered quickly. Follow-up of 1 to 56 months showed no recurrence of the hernia. Two patients complained of some epigastric pain and six patients had occasional mild reflux that was easily controlled medically. Laparoscopic repair of paraesophageal hernia is a safe procedure with a short hospital stay and recovery time. Using mesh graft decreases the risk of developing an iatrogenic parahiatal hernia. The addition of Nissen fundoplication is not necessary unless the patient has objective findings of reflux.
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PMID:Laparoscopic repair of paraesophageal hiatal hernia. 969 97

The hernia of the bladder in the scrotum is a highly uncommon observation. From the clinical standpoint the usual manifestation is a two-stroke voiding. The recommended urological examinations to reach a diagnosis are ultrasound, endovenous urography, retrograde urethrocystography and cystoscopy. Management includes the de-obstruction of the lower urinary tract, if present, resection of associated peritoneum, resection or reduction of the vesical hernia and repairment of inguinal path. The case contributed corresponds to a vesical hernia in a 72-year-old patient, with no obstructive cause, that was treated surgically by resection of the herniated bladder, with good morphological and functional results.
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PMID:[A massive hernia of the bladder into the scrotum. A report of a case]. 1008 40

Anderson Area Medical Center physicians have been provided disease-specific and procedure-specific profiles of their practice experiences for more than 5 years. For 4 years, physicians were provided reports, in a variety of formats, detailing their clinical outcomes and consumption of hospital resources in treating patients with acute myocardial infarction (AMI), pneumonia, cholecystectomy, stroke, congestive heart failure, and total hip replacement. For the past 18 months, physicians have been provided a uniform format of monthly physician-specific reporting for stroke, AMI, pneumonia, diabetes, congestive heart failure, cholecystectomy, total hip replacement, new-born delivery, angina, and hernia repair. Using only a modest PC platform with database, word processing, and graphics programs operating in a DOS environment, an effective disease-reporting and procedure-reporting program is provided to medical staff with 3 person-days of effort per month. Education-based physician-practice reporting is effective in encouraging more resource-efficient decision making on the part of medical staff members. Average length of stay and total charges can be reduced significantly by providing physicians with profiles that show them their relative ranking with peers of several outcome and resource variables. Actual aggregate reductions in average total charges for each of three groups of patients profiled following educational reporting to physicians were $203,680 (AMI), $220,296 (pneumonia), and $146,832 (hip replacement). Total benefit for these three educational reports was $570,808. If educational effects persist for 1 year in the physician groups, the annualized estimate of aggregate charge reductions for 390 AMI patients, 483 pneumonia patients, and 52 hip-replacement patients is $1,568,644. Cost savings to the hospital would be near $706,000.
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PMID:Lowering physician hospital resource consumption using low-cost, low-technology computing. 1016 17

Moderate hypothermia was induced in 30 patients with malignant middle cerebral artery (MCA) territory infarction. Patients were kept at 33 degrees C body-core temperature for 48 to 72 h, and ICP, CPP, and brain temperature were monitored. Outcome at 4 weeks and at 3 months after the stroke as well as side effects of moderate hypothermia were analysed. Mortality of malignant MCA infarction could be reduced from 80% in historical controls, to 43% (13/30) under hypothermia. During hypothermia elevated ICP values could be significantly reduced. Herniation due to a secondary rise of ICP after rewarming was the cause of death in all 13 patients. The most frequent complication of moderate hypothermia was pneumonia in 12 of the 30 patients (40%). Other severe side effects of hypothermia could not be detected. Moderate hypothermia may improve clinical outcome in patients with malignant MCA infarction.
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PMID:[Moderate hypothermia for the treatment of malignant middle cerebral artery infarct]. 1041 99

This report describes a case of hemorrhagic stroke that presented as an expressive aphasia after routine hernia repair under spinal anesthesia in an otherwise generally healthy middle-aged outpatient. Possible roles of preexisting migrainous headaches and perioperative ephedrine are discussed, but, as in most cases of perioperative stroke, the possibilities are numerous and the cause of the stroke difficult to determine.
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PMID:Hemorrhagic stroke after spinal anesthesia and minor surgery. 1526 23

Botulinic toxin (BT) is a new method of lowering intraurethral pressure in symptoms of obstructive voiding in patients with neurogenic dysfunction of the lower urinary tracts (LUT). Transperineal introduction of 100 units of BT type A (botox, Allergan) was used under electromyographic control into the external urethral sphincter of 9 patients (6 males and 3 females) with LUT neurogenic dysfunction aged 17 to 68 years (mean age 37.2 years). Two patients had subnormal detrusor contractility due to myelodysplasia and diabetic polyneuropathy, two other patients--non-incontinent striated urethral sphincter after hemorrhagic stroke and spinal contusion, five patients suffered from detrusor-sphincteral dyssynergia (DSD) resultant from Schmorl's hernia, multiple sclerosis, Charcot-Marie disease and ischemic stroke of the spinal cord. Three patients had cystostomic drainage. The rest of the patients complained of dysuria, three patients performed self-catheterization, mean volume of the residual urine was 170 ml (180-240 ml). In 10 days residual urine was not found in 2 patients with subnormal detrusor contractility and in 4 patients with DSD. Abdominal pressure fell from 75 to 39 cm, on the average. In DSD patients maximal detrusor pressure fell from 59 to 29 cm, on the average. Mean maximal urinary flow rate rose from 4.3 to 9.6 ml/s. In 20 days, on the average, suprapubic fistula healed in all the patients. In a month, therapeutic effect persisted in all the patients. Complications, side effects were not registered. BT treatment to induce adequate urine evacuation in neurological patients is a promising approach in neurourology. Further studies should find answers to questions about regimen of BT introduction, loss of sensitivity, new indications in urology.
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PMID:[Botulinic toxin in patients with neurogenic dysfunction of the lower urinary tracts]. 1545 54

Coma or stroke with secondary brain malperfusion is usually considered a strong contraindication for emergent surgical treatment of acute aortic dissection. Herein, we present the case of a 30-year-old woman who presented with sudden left hemiplegia and level-7 coma on the Glasgow Coma Scale. Transthoracic echocardiography showed type A aortic dissection. Although the patient was unable to communicate, her family approved an emergency Bentall operation. She regained consciousness but developed anisocoria and Glasgow Coma Scale level-4 coma 30 hours after the operation. Computed tomography showed massive cerebral infarction with hernia of the uncus gyri hippocampi. Emergency surgical cerebral decompression was performed. The patient survived; after 1 year, she had full mental acuity and minor left motor sequelae.
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PMID:Combined cardiac-neurosurgical treatment of acute aortic dissection, stroke, and coma. 1861 54


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