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

Although the survival for infants with abdominal wall defects (AWD) has dramatically improved, agreement on the optimum surgical approach has not been reached. From October 1970 through March 1983, 31 neonates with gastroschisis and 14 neonates with omphalocele were treated. Reduction of the herniated viscera with primary fascial and skin closure was performed in 30% of the gastroschisis patients and 64% of the omphalocele patients. The remaining infants were managed by staged reduction of the herniated viscera using a Silastic sac. Overall, 27 of 45 patients (60%) were treated by staged reduction. Our procedure for staged reduction includes application of a Silastic sac as soon as the infant is stable. The herniated contents are reduced as rapidly as possible so that the prosthetic sacs can be removed within seven days. Abdominal wall stretching, "milking" of the intestinal contents into the stomach for decompression and a gastrostomy tube are avoided. The duration of hospitalization was not influenced by the method of abdominal wall closure in the gastroschisis infants. However, the hospitalization was approximately 10 days longer for those omphalocele patients managed by staged reduction. Complications which occurred in these patients include: respiratory distress (1); wound infection after removal of the Silastic sac (2); intestinal fistula (1); intestinal resection (3); intraabdominal sepsis (1); and incisional hernia (3). There was one death in the omphalocele group and three deaths in the gastroschisis group. Therefore, the overall survival for the 45 patients with AWD was 91%. Staged reduction of the herniated abdominal contents can be a safe, uncomplicated method of obtaining abdominal wall closure in neonates with AWD.
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PMID:Staged reduction using a Silastic sac is the treatment of choice for large congenital abdominal wall defects. 622 20

Neonatal sepsis due to group B beta-hemolytic Streptococcus (GBS) is reported to occur in about 1 out of 330 live births. Right-sided Bochdalek hernia (RBH) occurs in about 1 of 20,000 live births. The combination of group B streptococcal sepsis and delayed appearance of a right Bochdalek hernia is an infrequently reported phenomenon--18 patients have been previously reported in the English literature. We add four patients from our own experience to these previous reports. Since approximately 10% to 15% of the newborn population are exposed to group B Streptococcus we suspect that the inadequate diaphragmatic motion on the side of the Bochdalek hernia predisposes the child to development of septicemia and/or pneumonitis. Once the etiology has been established and appropriate antibiotic therapy instituted, progressive improvement in the patient's course should be seen. This is in contrast to a very significant mortality rate in many of the patients having early onset GBS. Any child, therefore, surviving early onset GBS only to deteriorate again, should be suspected of having an associated right Bochdalek hernia, and diagnostic steps should be taken to evaluate the integrity of the right diaphragm.
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PMID:Diagnosis and treatment of right Bochdalek hernia associated with group B streptococcal pneumonia and sepsis in the neonate. 635 94

We report our experience with 1,000 consecutive abdominal wound closures using continuous monofilament polypropylene (Prolene) sutures. Wound dehiscence occurred in four patients (0.4%), and incisional hernia occurred in seven patients (0.7%). The incidence of persistent suture sinus was less than 1%. A comparison of these results with the reported data showed that this method was at least equal to other types of wound closure. While the polypropylene suture is more difficult to handle than traditional sutures, it is probably the preferred suture for contaminated and dirty wounds. It has eliminated the need for retention sutures in our practice, and its use as a continuous, running closure has offered the advantage over the usual interrupted technique of being simpler, faster, and more cost effective. Sepsis has continued to be the greatest cause of failure of abdominal wounds to heal.
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PMID:Abdominal wound closure with a continuous monofilament polypropylene suture. Experience with 1,000 consecutive cases. 635 47

Laparotomy was performed on 579 children at the University Clinic of Paediatric Surgery in Mainz from 1.1.1975 to 31.12.1982. The children were up to 15 years of age; appendicitis or inguinal and umbilical hernia cases were not included. Postoperative sepsis occurred in 74 patients (12.8% of all children with laparotomy); in 51 cases positive bacteriological findings were seen besides the clinical and clinicochemical ones. Sepsis morbidity was particularly high in children who had not yet completed their first year of life (postoperative sepsis occurring in approximately every fourth infant); among the disease patterns, the following were particularly prominent: Defects of the abdominal wall (23 out of 50 children developed postoperative sepsis); intestinal atresia (18 out of 59 children); intestinal perforation (11 out of 39 children). In addition, sepsis morbidity was enhanced after relaparotomies. Gram-negative bacteria were most frequent among the 51 patients with bacteriologically positive findings; these bacteria consisted mostly of representatives of the group of enterogenous pathogens. These groups of bacteria were also the most frequently occurring pathogens in mixed and secondary infections. 33 out of 74 children with postoperative sepsis died. The mortality rate was 68% in prematurely born infants compared with mature newborns. Lethality was highest among children with congenital defects of the abdominal wall and intestinal perforations. Among the patients with bacteriologically positive findings the lethality was particularly high with multiple attacks of sepsis, in case of septitides caused by multiple pathogens, by Candida albicans and after relaparotomy.
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PMID:[Importance of infection following laparotomy in childhood]. 639 38

Ventral hernia was induced surgically in sheep and either left unrepaired (5 animals), repaired with plastic mesh (20 animals) or with carbon fibre (20 animals). In unrepaired animals the hernia persisted. Three hernias recurred in the group repaired with plastic mesh, 2 as a consequence of sepsis. All the hernias repaired with carbon fibre remained sound over periods varying from 8 months to 2 years. There was a gradual invasion of the carbon fibres by collagenous tissue and thus a transition from one to the other of the stress of maintaining the abdominal wall intact.
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PMID:The use of flexible carbon fibre in the repair of experimental large abdominal incisional hernias. 644 36

To obviate any limitation in abdominal volume, the girth in 44 neonates was increased significantly by the insertion of either Marlex mesh or Prolene mesh as a permanent midline fascial prosthesis. Concomitant primary wound closure was then accomplished through mobilization of laterally based skin flaps. Without exception, the resultant coelom was adequately spacious, as reflected postoperatively by both ventilation and venous return being unimpaired. Four babies died, three as a result of antecedent cerebral hypoxia complicating diaphragmatic herniation and one as a result of sepsis. Indications for the procedure were a massive omphalocele in 31 infants, gastroschisis in nine and a huge diaphragmatic hernia in four. Wound dehiscence with exposure of the fascial prosthesis occurred twice, once because of a cautery burn of the skin and after minor wound infection in the second. Revision of the initial abdominal wall repair was required in both of these babies as well as for incomplete extrusion of Marlex mesh in three older children. Prolene is now preferred for fascial prostheses. Prime advantages of the technique include immediate enlargement of the peritoneal capacity, rare necessary for ventilatory support, maintenance of abdominal support by a fascial gusset, elimination of infectious complications attending more delayed closures of wound and peritoneum and the uncommon need for later operative revision.
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PMID:Immediate permanent fascial prosthesis for gastroschisis and massive omphalocele. 645 68

Ninety-seven Royal Naval and Royal Marine officers and ratings undergoing repair of a unilateral inguinal hernia were randomized postoperatively into two groups: A, those who returned to full working duties 21 days after operation; B, those who returned to light duties 21 days after operation and to full duties at 3 months. Patients were reviewed at 3 and 12 months. One patient was withdrawn because of the development of late sepsis. Two patients in group B developed a recurrence of hernia within 1 year. No patient who returned to full duties at 21 days was unable to do any duty assigned to him. In a concurrent trial 119 male civilian patients were treated in the same hospital under identical conditions. All patients were reviewed 21 days after operation and were randomized into two groups: C, those advised to return to work immediately; D, those given no advice. Patients in group C returned to work in a mean of 38 days (range 14-96 days), whereas those in group D returned in a mean of 71 days (range 14-280 days). There was no recurrence of hernia in either group within the review period. It is concluded that there is no contraindication to resuming physical work 3 weeks after the uncomplicated repair of a unilateral inguinal hernia, and that active encouragement shortens the interval before return to work.
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PMID:Early return to work after repair of a unilateral inguinal hernia. 662 21

Wound healing has been investigated in 373 patients undergoing surgery for obstructive jaundice and 760 anicteric patients undergoing cholecystectomy. Reduced wound healing manifested by a higher frequency of wound dehiscence (3.2 per cent vs. 0.5 per cent) and incisional hernia (10.3 per cent vs. 1.8 per cent) was seen in the jaundiced patients. The factors related to this reduced wound healing have been analysed by univariate and multivariate analysis. The independent factors related to wound dehiscence in the 373 jaundiced patients were: an initial low haematocrit (less than 30 per cent), an initial low plasma albumin (less than 30 g/l], a history of pancreatitis, a malignant obstructing lesion, and postoperative wound and/or abdominal sepsis. Haematocrit, albumin and postoperative wound and/or abdominal sepsis were also independent factors for incisional hernia. A raised plasma bilirubin was not of independent significance for either wound dehiscence or incisional hernia. It is concluded that reduced wound healing occurs in jaundiced patients and that this is due to the associated features of poor nutritional status (manifested by low haematocrit and low albumin) and malignancy and not to the raised bilirubin per se.
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PMID:Wound healing in obstructive jaundice. 670 75

Some newborn infants with either primary or secondary persistent pulmonary hypertension (PPHN) remain hypoxemic, hypercarbic, and acidotic despite therapeutic efforts. In autopsies of 23 infants who had PPHN, diffuse platelet-fibrin thrombi were present in the pulmonary microcirculation of eight (15.2 +/- 18.1 thrombi/cm2 lung tissue) and absent in 15 (0.2 +/- 0.3 thrombi/cm2 lung tissue), (P less than 0.004). Diagnoses in group A (thrombi) were pneumonia and sepsis (four patients), meconium inhalation (3), and primary PPHN (1); and in group B (no thrombi) pneumonia and sepsis (4), meconium inhalation (4), primary PPHN (4), hyaline membrane disease (2), and diaphragmatic hernia (1). The only significant differences between the two groups were the response to tolazoline infusion as assessed by changes in partial pressure of arterial oxygen (PaO2) and the platelet counts. Group A responded less favorably to tolazoline (14.8 mm Hg vs 83.6 mm Hg; P less than 0.05) and had lower platelet counts (51,000/microliter vs 128,000/microliter) (P less than 0.01) than group B. No significant differences could be detected in Apgar scores, duration or mode of mechanical ventilation, oxygen requirements, arterial blood gas tensions or pH, systemic arterial blood pressure, coagulation profile, amount of blood product transfusions, or intravascular catheter use. Pulmonary microthrombi should be added to the list of mechanisms for PPHN and may explain why some infants do not respond well to therapeutic efforts aimed at vasodilation. Thrombocytopenia and failure to respond to pulmonary vasodilators might suggest the diagnosis.
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PMID:Pulmonary microthrombi syndrome in newborn infants with unresponsive persistent pulmonary hypertension. 682 42

Clinical evaluation of cefmetazole were made in the treatment of bacterial infections in the newborn infants and the following results were obtained. 1) Five infants, 7 approximately 58 days of age, received a single intravenous one-shot injection of 22.2 approximately 24.5 mg/kg dose of cefmetazole, and blood concentrations were determined. The average level was 62.6 micrograms/ml (30 minutes), 46.3 micrograms/ml (1 hour), 26.8 micrograms/ml (2 hours), 8.7 micrograms/ml (4 hours) and 2.4 micrograms/ml (6 hours), and T 1/2 was 87.7 minutes. Almost similar values were obtained when the drug was given by a 30-minute drip infusion and sufficiently exceeded the MIC to the bacteria to which cefmetazole was indicated. 2) In two patients, who had been operated for choledochal cyst and received an intravenous drip infusion of the drug, the persistence of the blood concentration was remarkably long, T 1/2 being 192 and 222 minutes, respectively. This problem still remains to be elucidated. 3) The following 22 patients were treated with an intravenous one-shot or drip infusion of cefmetazole, i.e., 45.6 to 107.1 mg/kg divided in 2 approximately 3 doses; 14 patients aged 1 to 21 days, 2 aged 1 to less than 2 months, 3 aged 2 to less than 3 months and 3 aged older than 3 months. However, in purulent meningitis, larger dose was given intravenously 6 times daily. Diseases included sepsis (4 cases), purulent meningitis (3), peritonitis (1) SSS syndrome (3), subcutaneous abscess (2), urinary tract infection (8) and Salmonella enteritis (1), and their causative organisms were E. coli (13 strains), K. pneumoniae (1), S. typhimurium (1), S. aureus (6) and group B Streptococcus (1). Overall efficacy rate in 22 cases was 90.9%. i.e., excellent in 11, good in 9 and failure in 2. Two cases of failure were a patient with peritonitis and visceral eventration due to umbilical hernia and a patient with a chromosomal aberration and urinary tract infection caused by E. coli. Reasons for such a treatment failure appeared to reside in host factors. 4) Adverse reactions included each one case of skin rash and diaper rash, 3 cases of eosinophilia and 5 cases of elevation of transaminase levels, all of which were mild and transient. 5) Based on the above results, cefmetazole is considered to be a potent new antibiotic which should be indicated as the first choice drug in the treatment of neonatal bacterial infections. The recommended dosage is as follows: 50 mg/kg given intravenously 6 times daily for bacterial meningitis and 20 approximately 25 mg/kg intravenously or by a drip infusion 2 to 3 times daily for other infections.
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PMID:[Cefmetazole in the treatment of bacterial infections in the newborn (author's transl)]. 694 Oct 35


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