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

76 patients were interviewed by telephone 7-10 days after ambulant surgery for varicose veins, hernia inguinalis or sterilization (women). Of those who received spinal anaesthesia 24% developed headache and another 8% back-pain. Half of those who received general anaesthesia were too sleepy to recall the information they were given when they left the hospital. 22% of the patients reported that if they had to undergo the same operation again they would prefer to be admitted to hospital as inpatients. The interviews revealed many "minor" problems that could have been solved by a phone call on the first day after operation.
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PMID:[Ambulatory surgery and patients' experiences]. 918 62

Forty-three state-run medical schools admit 30000 students per year but only 3500 receive their diploma after 6 years of studies. After passing a special examination, 480 of 2000 residents choose surgery and train during twelve 6-month rotations. Surgical research is organized through government agencies, individual units, or volunteer groups. In 1992, of 8268114 procedures, appendectomy represented 4.15%; hernia, 4.09%; varicose veins, 3.61%; and cholecystectomy, 1.82%. Appendectomy has decreased from 306500 per year in 1980 (34% of all gastrointestinal surgical procedures) to 159900 (15%) in 1996, whereas cholecystectomy has increased from 64700 to 95300. Emergency gastrointestinal procedures represented 15% of all surgical procedures in 1996, doubling in the last 4 years (essentially for labor and endoscopic procedures). Ambulatory procedures have increased 12-fold since 1980, essentially (75%) in private practice. About 27% of 160000 appendectomies and 77% of 95300 cholecystectomies were performed laparoscopically in 1997. One person of 4 in France has or has had cancer, mainly due to tobacco abuse. In 1993, 32000 surgical procedures were performed for gastrointestinal cancer. Of 532000 deaths (1992), about 150000 were due to cancer, 10000 to alcohol-related disease, and 22000 to trauma. Transplantation in France increased from 3180 procedures in 1993 to 2807 in 1996, essentially lungs and heart and lungs. Between 60% and 100% of health expenditures are reimbursed by the government, the remaining being covered by private insurances. Approximately 60% of 4500 French surgeons are in private practice; 25% also have part-time hospital employment. Almost 40% of surgeons work full-time in hospitals.
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PMID:General and gastrointestinal tract surgery in France. 960 22

This study examines a list of 1,283 patients waiting for general and orthopaedic surgery in an outer London borough. In general surgery varicose vein and hernia surgery accounted for 60% of those waiting more than one year. Of those who had waited more than a year on the orthopaedic list 25% were waiting for knee replacement surgery. The average length of time spent waiting was 10 months, with some people waiting over 5 years. The impact of the numbers waiting a long time on aggregate waiting time was highlighted by weighting the numbers waiting by the months spent waiting. Analysis of urgency codes indicates that although there was a statistically significant relationship between urgency and the length of waiting time there were some anomalies. There was considerable inter-consultant variation in list size, waiting times and the case mix. Analysis of the flows onto the list and work done in one month showed that it would take a considerable time to clear some lists at present rates of activity. Disaggregated information such as this which explores the flows of patients on to and off of the lists is essential for the management of waiting lists and will become increasingly important as waiting lists become a feature of--'contracts'--service agreements, in the reformed NHS.
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PMID:Dissecting a waiting list. 1011 35

We have observed the effect of intubation and incision, as measured by the auditory evoked response (AER) and haemodynamic variables, in 12 patients undergoing hernia repair or varicose vein surgery who received remifentanil as part of either an inhaled anaesthetic technique using isoflurane or as part of a total i.v. technique using propofol. Anaesthesia was induced with remifentanil 1 microgram kg-1 and propofol, neuromuscular block was achieved with atracurium 0.6 mg kg-1 before intubation, and anaesthesia was maintained with a continuous infusion of remifentanil in combination with either a continuous infusion of propofol or inhaled isoflurane. The AER and haemodynamic variables were measured before and after intubation and incision. The effects of intubation and incision on the AER and haemodynamic variables were not significantly different between the remifentanil-propofol and remifentanil-isoflurane groups. However, the study had a low power for this comparison. When the data for the two anaesthetic combinations were pooled, the only significant effects were increases in diastolic arterial pressure and heart rate immediately after intubation; these were not seen 5 min after intubation. There were no cardiovascular responses to incision. There were no significant changes in the AER after intubation or incision.
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PMID:Effect of remifentanil on the auditory evoked response and haemodynamic changes after intubation and surgical incision. 1019 95

A 16-year-old male experienced a sudden attack of back pain while walking through the corridor of school which required emergent hospitalization. Except for the back pain, no neurological symptoms were noted. Magnetic resonance (MR) imaging indicated an angiopathy-like flow void in the epidural region at Th 3-5 which seemed to explain the patient's back pain. Thoracic laminectomy at Th 3-5 and resection of the affected site were performed. Pathologically, the resected lesion only had a dilated normal vein and no findings indicating vascular deformity. The patient's outcome was good and no relapse of pain has occurred for about 2 years since the operation. Although some authors have reported vascular deformity with spinal epidural hemorrhage or varices with lumbar hernia of the intervertebral disc, there is no report concerning spinal epidural varices with pain only. The present case seemed to be a rare event and is reported here.
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PMID:Spinal epidural varices. 1053 79

Groin swelling first evokes inguinal or femoral hernia but many other conditions may account for it. We describe varicosities of round ligament in a 27-year-old pregnant woman. She presented with a groin mass mimicking an inguinal hernia. Diagnosis was made during surgical exploration. This case report strengthens the fact that varicosities of the round ligament, favoured by hormonal and mechanical factors, should be evoked in a pregnant woman complaining of a groin mass. Ultrasonographic examination of the groin should be performed in such cases to avoid unnecessary surgery.
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PMID:Round ligament varicosities mimicking inguinal hernia: a diagnostic challenge during pregnancy. 1186 10

Wound infection after clean surgery (the majority being hernia, varicose vein and breast surgery) is often greatly underestimated. If a trained and blinded observer is involved using close and prolonged surveillance to at least 30 days postoperatively with appropriate definitions or wound scores, an infection rate of up to 15% or more may be found. Equally controversial is the value of prophylactic antibiotics in preventing postoperative wound infection; there is no clear cut evidence of efficacy and some random controlled trials (RCTs) have shown no differences at all. There is a need for guidelines to be drawn up but further RCTs may be needed. An alternative to antibiotics is the systemic warming of patients or the local warming of the operative site prior to surgery. In day case surgery in particular, patients may have been deprived of fluids for 12h prior to surgery; they may become cold whilst waiting for surgery dressed in a theatre gown; and their apprehension may not be controlled with anxiolytics. The inflammatory response may be obtunded with an increased risk of superadded infection or poor healing in cutaneous tissue resulting in wound separation and fat necrosis. Only a third of sampled purulent discharges grow skin organisms such as Staphylococcus aureus or epidermidis. In a study of 421 patients the 138 randomly assigned to local warming (Warm Up, Augustine Medical) had a wound infection rate of 3.6% compared with another group of 139 randomly assigned to systemic warming (Bair Hugger, Augustine Medical) of 5.8%. A standard-treated third group of 139 had a wound infection rate of 13.7% (P<0.001). The warmed patients also had significantly lower wound scores based on 4 systems, had higher skin temperatures and capillary flow prior to surgery and were prescribed fewer postoperative antibiotics by their family doctors in the 6 postoperative weeks (15.9% vs 6.5%; P=0.002). Wound infections are more common than generally accepted if they are looked for by close surveillance. Antibiotics may be avoided by the use of warming with the lessening of the risks of allergy, resistance and emergence. It is uncertain whether antibiotic prophylaxis has a role in clean wound surgery. Breast surgery carries the highest risk of wound infection and this may risk delay in receiving planned adjuvant chemotherapy or radiotherapy. Perioperative warming of the operative site may be of greatest value in this group of patients.
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PMID:Antibiotic prophylaxis in clean surgery: clean non-implant wounds. 1193 88

Live donors are becoming an increasingly important source of donor organs in liver transplantation; however, long-term functional aspects of recovery from donor right hepatectomy are unknown. We analyzed donor outcomes at 1-year follow-up. We performed a single-center retrospective analysis of 70 right hepatectomy donors. Six-week and 1-year postoperative follow-up results were compared to preoperative baseline values. Ultrasonography was performed in all donors at 6 weeks and as clinically indicated. All donors were alive and well at the end of the study period. Of 66 right hepatic donors, only 22 (32%) were fully compliant with a 1-year follow-up visit. All those not compliant were contacted by phone. All complications except 1 (late finding of portal vein thrombosis) occurred in the perioperative (90-day) period. The incidence of bile leak was 4.3%, incisional hernia 20%, and autologous transfusion 1.0%. There were no aborted procedures. In those compliant with full 1-year follow-up, total bilirubin, aspartate aminotransferase, and alanine aminotransferase were normal in 97%. A total of 5 donors were noted to have persistence of asymptomatic thrombocytopenia beyond the perioperative period (90 days). These were investigated with Doppler sonography. Sonography was unremarkable in 3 of the 5, while 2 had abnormal findings: splenomegaly alone in 1, and splenomegaly with portal vein thrombosis in the other. Magnetic resonance angiography was performed in both, and the patient with portal vein thrombosis underwent endoscopy, which failed to reveal varices. Neither has clinical portal hypertension. Both remain asymptomatic albeit with stable thrombocytopenia. In conclusion, the majority of complications after donor right hepatectomy occur in the perioperative period. Later findings may include asymptomatic thrombocytopenia, with an incidence possibly as high as 23%, though the significance of this finding remains uncertain. Larger-scale studies are needed to confirm the true incidence and clinical significance of persistent thrombocytopenia in the donor hepatectomy population. Strategies to improve compliance with 1-year follow-up visits need to be developed.
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PMID:One-year morbidity after donor right hepatectomy. 1549 45

Gender-, age- and race-related generalised joint hypermobility (GJH) is elucidated, based on publications that have used validated criteria for GJH. Furthermore, we analysed the connection between GJH and the clinical criteria for benign joint hypermobility syndrome (BJHS), and we looked for literature on the treatment of BJHS. There seems to be evidence in support of an increased prevalence of hypermobility among children, females and certain races when the diagnosis of hypermobility is based on the Carter and Wilkinson criteria (> or =3 positive tests out of 5) and/or Beighton's tests (> or =4 positive tests out of 9). However, there are no unequivocal statements that hypermobility predisposes to the various clinical situations used as major or minor criteria for BJHS, e.g., arthralgia, low back and pelvic pain, joint luxation, soft tissue rheumatism, abnormal cutis or genitourinary prolapse, varicose veins and hernia. There have been no randomised controlled studies of the effect of treatment.
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PMID:[Generalised joint hypermobility and benign joint hypermobility syndrome. II: epidemiology and clinical criteria]. 1630 62

Absorbable sutures are in use for more than 30 years. Tissue reactions which might be associated with suture material have rarely been reported in the past. After a long period without complications caused by suture material we observed 12 cases of unexpected tissue reactions after clean operations. Our patients 3-8 weeks after uneventful elective clean operations (varicose vein, hernia, benign soft tissue tumor) had unexpected tissue reactions (inflammation, granuloma, extrusion, fistula, abscess) in the vicinity of Vicryl, suture material (8 cases with Vicryl, 4 cases with Vicryl plus. After removal of the suture material and the granulomatous tissue wounds healed without any further disturbance. These tissue reactions have been observed in patients with subcuticular sutures as well as in patients with deeper located vein ligatures. It is well known that next to patient-associated and surgeon-related factors biomaterials might have an impact on postoperative inflammatory process and healing. We use Vicryl, suture material for ambulatory surgery since 1999 and did not see complications for a long period up to now. 11 of the patients were observed within several weeks in summer 2005, whereas only one patient has been observed in the year 2004. All 11 patients observed in 2005 had a combination of Vicryl/ Vicryl plus suture material in deep/subcutaneous and Dermabond glue for skin closure. We do not know the cause for this change. For clarification evaluation of the tissue reactions of these biomaterials including possible interactions or combined reactions should be done.
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PMID:Adverse events of sutures: possible interactions of biomaterials? 1635 67


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