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

Normal-appearing tissues in non-native sites constitute one of the more common morphologic expressions of abnormal development. The presence of pancreas in the wall or on the serosa of the small intestine and adrenal cortical tissue in a hernia sac are two familiar examples of heterotopias. We report our experience of mature glial tissues in the soft tissues of six children who were between the ages of 4.5 months and 2 years when they presented with a solitary mass on the chest wall (three cases), scalp (two cases) and gluteal region (one case). These tumors were all characterized by pale-staining fibrillary foci of mature neuroglia, which were intensely immunoreactive for glial fibrillary acidic protein in each case. One of the two scalp lesions was accompanied by a nodule of cartilage and a meshwork of pseudovascular spaces, which were decorated with antibodies to vimentin and epithelial membrane antigen consistent with meningothelial tissue. The histogenesis of the neuroglial tissue in the gluteal region and scalp was, respectively, on the basis of a recurrence of a sacrococcygeal teratoma in the former case and sequestered encephaloceles in the last two cases. A facile explanation for the occurrence of neuroglial tissue in the soft tissue of the chest wall in the remaining three cases was less than obvious as none of the patients had accompanying neurologic or anatomic defects and all were in a nonmidline location. These three cases of soft tissue gliomatosis of the chest wall are similar to an earlier example in the recent literature whose histogenesis was as enigmatic as it proved to be in our three cases. Although the histologic and immunohistochemical features of these six cases were very similar in each instance, their origin varied from a recurrent sacrococcygeal teratoma and sequestered encephaloceles to essentially unknown.
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PMID:Soft tissue gliomatosis. Morphologic unity and histogenetic diversity. 855 3

Down syndrome may be associated with many complications. Among the malignancies associated with Down syndrome, leukaemia is the most common. This is a case report of a patient with Down syndrome associated with both a retroperitoneal teratoma and a Morgagni hernia.
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PMID:Down syndrome associated with a retroperitoneal teratoma and Morgagni hernia. 900 6

In a limited number of conditions in utero surgery may be life-saving, such as some cases of congenital diaphragmatic hernia, cystic adenomatoid malformation of the lung, sacrococcygeal teratoma and lower urinary tract obstruction. Postoperative premature labour and its extreme invasiveness have been major drawbacks for open fetal surgery. More recently the merger of fetoscopy and advanced video-endoscopic surgery has been the basis of the concept of endoscopic fetal surgery. In order to evaluate the opportunities of 'fetendo' surgery, animal models have been developed to test the safety of the endoscopic approach, and the feasibility of surgical manipulations on the fetus. In the non-human primate, a lesser invasiveness of endoscopy over open surgical approach was demonstrated, by a significant decrease in uterine activity in comparison with hysterotomy. The main application of fetoscopy today is the surgical treatment of complicated or abnormal monochorionic twin gestations. Fetoscopic laser coagulation of chorionic plate vessels is suggested as a causal therapy for severe feto-fetal transfusion syndrome. Survival rates are around 55 per cent with an incidence of five per cent of neurological morbidity. Fetoscopic cord ligation is associated with a 66 per cent survival rate, but unfortunately also with a risk of 30 per cent for PPROM prior to 32 weeks. Although still in its early experimental phase, endoscopy seems to offer new hope for surgical fetal therapy. Though conceptually very tempting, the development of endoscopic fetal surgery should follow the formal guidelines, as earlier formulated for open surgery by the International Fetal Medicine and Surgery Society. The prospective registration of worldwide experience is advocated and a randomized trial of laser therapy versus amniodrainage is announced.
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PMID:Operative fetoscopy: new perspective in fetal therapy? 950 43

Fetal therapy is a logical extension of fetal diagnosis. Fetal surgery has been performed in humans for the past 10 years. During this time, technical obstacles have been overcome and the natural history of many fetal disorders has been defined. A select group of disorders amenable to potential improvement by fetal treatment has been identified including fetal urinary tract obstruction, fetal diaphragmatic hernia, fetal congenital cystic adenomatoid malformation and fetal sacrococcygeal teratoma. The fetal surgical experience with each of these lesions is reviewed and the maternal risk of fetal surgery is discussed.
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PMID:Fetal surgery: a brief review. 963 52

Advances in prenatal imaging modalities such as ultrasound and magnetic resonance imaging have permitted the more frequent and accurate diagnosis of congenital malformations. Fetal surgical intervention has been reserved for those malformations that lead to fetal demise or are life-threatening in the neonatal period. We review the current indications for intervention in fetuses diagnosed with congenital lung lesions, congenital diaphragmatic hernia, sacrococcygeal teratoma, and obstructing airway lesions. A discussion of the recent interest in the fetal repair of severe myelomeningocele is also included.
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PMID:Perinatal management of fetal malformations amenable to surgical correction. 1021 19

The purpose of this report is to assess the impact of fetal surgery on future maternal fertility, subsequent pregnancy outcome, and the incidence of pregnancy complications. Retrospective data were collected on 70 mothers who underwent fetal surgery between April 1981 and June 1996. Indications for open hysterotomy fetal surgery included congenital diaphragmatic hernia (n = 44), congenital cystic adenomatoid malformation of the lung (n = 11), urinary obstruction (n = 9), sacrococcygeal teratoma (n = 4), heart block (n = 1), and acardiac-acephalic twin reduction (n = 1). The following data were obtained: number of pregnancy attempts, number of successful pregnancies, pregnancy outcome including obstetrical and neonatal complications, and infertility after fetal surgery. There were 45 respondents, of whom 35 attempted subsequent pregnancies. Thirty-two were successful, resulting in 31 livebirths. Two women had a strong prefetal surgery history of infertility, 1 has only attempted to conceive for 3 months. We report this experience because the effect of open fetal surgery on futrue fertility is such an important question for our patients and referring physicians. This analysis suggests that hysterotomy and open fetal surgery has a negligible impact on maternal fertility.
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PMID:Maternal fertility is not affected by fetal surgery. 1036 73

After more than two decades of experimental and clinical work, fetal surgery has become an accepted treatment modality for selected fetuses with life-threatening anomalies. Color Doppler ultrasound and ultrafast fetal magnetic resonance imaging have enhanced the accuracy of prenatal evaluation traditionally made by ultrasound alone. Fetal lung masses associated with hydrops are nearly 100% fatal. These lesions can be resected in utero if they are predominantly solid or multicystic. Thoracoamniotic shunting may be effective in the setting of a single large predominant cyst. Fetuses diagnosed with left congenital diaphragmatic hernia before 26 weeks' gestation with liver herniation and a sonographic right lung to head circumference ratio (LHR) of less than one may benefit from fetal tracheal occlusion. Fetal sacrococcygeal teratoma complicated with placentomegaly, hydrops, or progressive high output heart failure may benefit from in utero resection of the tumor. Although preterm labor still remains the Achilles heel of open fetal surgery, effective tocolysis may, in the future, expand the scope of fetal surgery.
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PMID:Open fetal surgery for life-threatening fetal malformations. 1063 May 41

Prenatal magnetic resonance imaging (MRI) has several advantages over obstetric ultrasound, including a larger field of view, superior soft-tissue contrast, more precise volumetric measurements, and greater accuracy in the demonstration of intracranial abnormalities. Prenatal MRI has been shown to positively and incrementally influence management in a substantial proportion of patients being considered for fetal intervention. Despite these findings, precise indications for prenatal MRI in the setting of fetal surgery are not yet established, because both prenatal MRI and fetal surgery are relatively new techniques that remain in evolution. Conditions in which prenatal MRI appears to contribute to fetal surgical planning and postoperative evaluation are described in this review. These conditions include congenital diaphragmatic hernia, cystic adenomatoid malformation, sacrococcygeal teratoma, complicated twin pregnancies, upper airway obstruction, and myelomeningocele.
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PMID:Role of magnetic resonance imaging in fetal surgery. 1121 15

Laparoscopic suturing and repairing of the fascial opening at 10- to 12-mm cannula puncture sites is well established; however, closing a 5-mm cannula wound is not well documented. We often leave the wound open without suture and cover it with gauze after removing the surgical drainage tube. An unusual early postoperative complication of laparoscopic surgery was an incarcerated hernia in a 5-mm cannula site. The 9-year-old girl underwent laparoscopic surgery due to an 8-cm ovarian mature teratoma. After 7 days, she came to our hospital because of a protruding mass in the left cannula wound. The mass was excised, and incarcerated fallopian tube torsion with necrotic change was diagnosed.
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PMID:Incarcerated hernia in a 5-mm cannula wound. 1150 92

A full-term newborn with karyotype 46, XX was delivered by cesarean section. She had severe respiratory distress and substernal retraction, and underwent emergency operation, but she died on the same day due to respiratory failure. The mother, 26-year-old prima gravida with no history of twinning, had been examined with ultrasonography at the 34th week of her pregnancy, which revealed a fetus with edema of head and neck region, a probable diaphragmatic hernia, polyhydramnios, and a large mediastinal mass with solid and multicystic parts with hypoplasia of the lungs. Autopsy revealed a 9 x 5 x 3 cm lobulated mediastinal mass with both solid and cystic areas, displacing the lungs and the heart postero-inferiorly and thymus anteriorly. The lungs were hypoplasic. Microscopically, the mass showed mature epithelial and mesenchymal tissues with primitive mesenchyme and immature neuroepithelium. All these findings led to the diagnosis of an immature teratoma. Mediastinal teratomas are rare and life-threatening, but early diagnosis and surgical intervention in a newborn with sufficient lung maturation may provide a long survival.
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PMID:Congenital mediastinal immature teratoma: a case report with autopsy findings. 1185 87


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