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

Actinomycotic infection of the female genital tract is rare. Actinomycosis is a chronic suppurative granulomatous infection that is characterized by formation of abscesses, multiple draining sinuses and appearance of tangled mycelial masses or granules in the discharges and tissue sections. 2 cases of tubo-ovarian actinomycosis are reported. The 1st case presented clinical with gastrointestinal symptoms and a ventral scar hernia following an operation for a non-healing abdominal wound 6 months earlier. The 2nd case sought medical attention for backache and leucorrhea of 4 years' duration. Exploratory laparotomy in the 1st case revealed tubo-ovarian masses; the vermiform appendix was not traceable. The uterine cavity in the 2nd case harbored a wooden stick. Direct extension from established ileocacal actinomycosis was believed to involve the female genital adnexae in the past. Association of tubo-ovarian actinomycosis with the presence of a foreign body in the female genital tract has been reported sporadically in the literature, yet an increase in the incidence may be expected because of the frequent use of intrauterine contraceptive devices in recent times. It is suggested that in women presenting clinically with vague abdominal symptoms, backache and discharge, actinomycosis should be considered and ruled out with the help of cytologic and proper microbial culture methods. Once the diagnosis is established, the infection can be treated with good results with penicillin.
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PMID:Tubo-ovarian actinomycosis. 723 72

The authors analyzed pain drawings of patients having lumbar disc surgery and tried to correlate pain pattern to disc pathology and level. Preoperatively, patients having spinal surgery were asked to draw on a standardized form the localization, postural variation, and modality of their pain. In this study, 185 consecutive patients with unilateral and unisegmental L4-L5 and L5-S1 hernias were analyzed. The pain drawings were coded and read blindly; each drawing was divided operationally into anatomic areas, and the type of pain symbol in each pixel was recorded, digitized, and analyzed by stepwise discriminant analysis. For predicting the level of the lesion, the most important variables were pain on the anterolateral aspect of the leg (L4-L5) and pain radiating to the posterior aspect of the foot (L5-S1). For predicting the grade of herniation, the most discriminative factors were pain radiating to the foot (sequestrated hernia) and bilateral back pain (protruded hernia). Pain drawing facilities communication and documentation. In addition, it is an aid to diagnose the level and degree of the hernia, and therefore is useful for selecting patients who might benefit from disc surgery. For scientific purposes, data are digitized easily, allowing analyses of large populations.
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PMID:Pain and pathology in lumbar disc hernia. 758 44

This study was carried out in order to assess the clinical results after percutaneous automated nucleotomy with regard to predictive factors for the outcome. Selection criteria included patients with predominance of low-back pain, diffuse posterior disk bulges and concomitant spinal stenosis who are not normally accepted for nucleotomy. In all, 142 patients were treated. The overall success rate after an average observation time of 21 months was 56%. The results were not influenced by whether a diffuse posterior bulge or a focal hernia had been treated or not (p = 0.449). Spinal stenosis (p = 0.043) and disk space narrowing exceeding 25% of the expected width (p = 0.017) were associated with a poor outcome. By excluding these categories and patients with symptoms from more than one disk level, the success rate rose to 70%. With this selection, the results were equally good in patients with predominantly low-back pain compared to those with predominantly sciatica (p = 0.490).
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PMID:Clinical results after percutaneous automated lumbar nucleotomy. A follow-up study. 761 23

The problem of low back pain has reached epidemic proportions in the industrialized nations. The predicament of back pain is common, 30-40% of our populations from 10-65 years old report such trouble to occur on a monthly basis. In 1-8% this results in work-disabling back pain. Only in very few of these patients can physicians diagnose a definite pathoanatomical cause for the pain. It can be deduced that psychosocial factors, including insurance benefits are of importance for this variation. Sweden, with 100% sickness benefits, has the highest disability rate. Few non-surgical methods have proven effective in rendering the patient better for him to return to work. Even fewer studies demonstrate any benefit from surgery, simple open removal of a proven disc hernia being the only exception. For patients with unproven diagnostic labels such as facet arthritis, degenerative disc disease, internal disc resorption and instability, no evidence exists that any type of surgery is cost-effective. More attention must be paid to illness behaviour by anyone treating chronic low back pain syndromes (> 3 months). Such psychological reactions to an originally nociceptive pain stimulus somewhere in the motion segment, must be elucidated and addressed, before embarking on risky and expensive treatment modalities including surgery. It is time for all of us, politicians as well as physicians, to distinguish what types of support will contribute to our nations' future and which ones will undermine it. Our welfare systems are at stake.
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PMID:Chronic pain--the end of the welfare state? 786 65

A revision of 15 cases of back pain and radiological features characteristic of anterior or posterior limbus vertebrae is presented. We comment on the radiological findings observed in the various imaging studies performed (conventional radiology, CT and MRI), which were attributed to the herniation of disc material into the vertebral body. In three patients who were followed up 12 years after the diagnosis, the initial roentgenograms of limbus vertebrae progressed in adult hood into radiological images characteristic of Schmorl's hernia as a sequela.
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PMID:Intervertebral disc herniations (limbus vertebrae) in pediatric patients: report of 15 cases. 815 77

Thoracic disc herniation is a rare and slowly progressive disease which most commonly occurs at the lower thoracic spine without any preceding trauma. We reported a case with acutely developed vesicorectal dysfunction due to a ruptured disc at Th 11-12. This symptom disappeared soon after disc removal via the transpedicular approach combined with transversectomy. This 45-year-old woman suddenly suffered, without previous trauma, from severe back pain radiating down to the posterior thighs. Since difficulty in urination and defecatory incontinence succeeded two days later, she was transferred to our hospital. Neurological examination on admission revealed anesthesia below S1, hypotonic bladder with almost perfectly preserved urinary sensation, complete lack of anal reflex, and only weak motor function in the lower extremities. Both knee and ankle jerks were diminished bilaterally. A herniated disc was initially suspected at L5-S1 on the MRI, but denied by both myelography and CT myelography. These studies showed a disc hernia compressing the cord at Th 11-12 on the left side. Since the hernia was located centrolaterally, we employed the transpedicular approach. To make removal of the more centrally located hernia easier, we further added transversectomy of the twelfth vertebra. This hernia was successfully removed under the operating microscope without further damage to the cord being incurred. We did not perform any instrumental fixation, because we thought preservation of the rib and costvertebral joint could contribute to the stability of the spine. Her vesicorectal symptom subsided immediately after the operation. She was free of any symptoms except for the remaining mild perianal numbness a year and seven months postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Lower thoracic disc herniation with acutely developed vesicorectal dysfunction: case report]. 832 56

The combination of percutaneous manual and endoscopic Ho:YAG laser discectomy (PELD) is a new minimal intervention technique in treating patients with herniated lumbar discs that do not penetrate the posterior longitudinal ligament. The results in 100 patients treated with PELD were compared randomly with those in 100 patients treated by chemonucleolysis with chymopapain (CN) and 100 patients treated by automated percutaneous lumbar discectomy (APLD) at the same hospital. We followed the 300 patients postoperatively for 1 year, with physical examination, postoperative plain lumbosacral radiography, CT, MRI and a self-assessment questionnaire. Some 68% of the patients in the PELD group considered the outcome as excellent or good and 23% as fair; the corresponding figures were 55% and 27% in the CN group, and 48% and 32% in the APLD group. Nine percent of the patients in the PELD group underwent open microdiscectomy or were suffering from back pain with sciatica, compared with 18% in the CN group and 20% in the APLD group. PELD showed better extraction of the hernia mass than APLD and a lower rate of low back pain and less decrease in disc height than CN.
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PMID:[Comparison of percutaneous manual and endoscopic laser diskectomy with chemonucleolysis and automated nucleotomy]. 862 46

Herniation of a lumbar disc in the pediatric age group is rare. A 12-year-old female twin developed backache and left sciatica after a mild lifting injury. Magnetic resonance imaging of the spine showed multilevel lumbar disc herniation. The patient was managed conservatively and her symptoms subsided within 6 weeks. Magnetic resonance imaging of her asymptomatic twin sister revealed a similar pattern of disc degeneration and multilevel herniation. This report emphasizes the hereditary nature of juvenile lumbar disc degeneration.
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PMID:Multilevel lumbar disc herniation in 12-year-old twins. 869 62

Ropivacaine is a new, long-acting local anaesthetic, prepared as a single enantiomer (the S form). Ropivacaine has a pKa of 8.07, a protein binding of approximately 94%, but a lower lipid solubility than bupivacaine. Extensive animal toxicological studies have shown a lower propensity for cardiotoxicity with ropivacaine than with bupivacaine. Studies in sheep have shown that the systemic toxicity of ropivacaine is not enhanced by gestation. Studies in human male volunteers have shown that ropivacaine is associated with at least 25% less CNS and cardiovascular adverse effects than bupivacaine following use of intravenous infusions of either drug at a rate of 10 mg/min, to a maximum dose of 150 to 250 mg. With its lower toxicity, especially cardiovascular toxicity, and less intense motor blockade, ropivacaine may have advantages over bupivacaine in epidural pain relief during labour. In general, comparative studies have shown ropivacaine and bupivacaine to have similar efficacy, but ropivacaine has a greater degree of separation between motor and sensory blockade than bupivacaine when it given epidurally for epidural pain relief during labour (as intermittent doses or continuous infusion) or for caesarean section. A significantly lower rate of instrumental deliveries and significantly higher neurological and adaptive capacity scores in neonates at 24 hours were noted for following epidural relief during labour with ropivacaine in a meta-analysis of 6 studies comparing this agent with bupivacaine. Ropivacaine is also of great interest when used as an epidural infusion for postoperative analgesia. There are a few studies evaluating epidural infusions of ropivacaine 0.1%, 0.2% or 0.3% (10 ml/h for 21 hours) after upper or lower abdominal or orthopaedic surgery, and epidural infusion of ropivacaine 0.2% (6 to 14 ml/h) after orthopaedic surgery. The studies show that ropivacaine provides postoperative pain relief in a dose-related manner with minimal or a low degree of dose-related motor blockade. Recommended doses of ropivacaine given epidurally to control postsurgical pain or labour pain are 20 to 40 mg as a bolus with 20 to 30 mg as a top-up with an interval > or = 30 minutes. Alternatively, ropivacaine 2 mg/ml (0.2%) can be given as a continuous epidural infusion at a rate of 6 to 14 ml/h (lumbar) or 4 to 8 ml/h (thoracic). Epidural ropivacaine 0.2% provides a good level of analgesia with minimal motor block, but the effects of a combination of ropivacaine and an opioid administered epidurally could have potential and need to be investigated. Preoperative or postoperative subcutaneous wound infiltration, during cholecystectomy or hernia repair, with ropivacaine 100 to 175 mg has been shown to be more effective than placebo and as effective as bupivacaine in reducing wound pain. The adverse effects associated with epidural administration of ropivacaine include hypotension, nausea, bradycardia, transient paraesthesia, back pain, urinary retention and fever. In comparative studies of ropivacaine and bupivacaine, the 2 drugs appear to be associated with a similar incidence of similar types of adverse effects excluding cardiovascular and CNS toxicities which are lower with ropivacaine. In conclusion, ropivacaine is effective for pain relief during labour and in the postoperative period. Ropivacaine is associated with less cardiovascular and CNS toxicity than bupivacaine and provides a greater degree of dissociation between sensory and motor effects producing less intense motor blockade and more rapid recovery to full patient mobilisation.
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PMID:Preliminary risk-benefit analysis of ropivacaine in labour and following surgery. 924 93

We report a case of a hernia through the thoracolumbar fascia in a young adult male who presented with pain and swelling in the thoracolumbar region. Surgical repair of the defect was performed in the superficial layer of the thoracolumbar fascia and, 18 months following surgery, he remained asymptomatic. The purpose of this report is to make clinicians aware of a thoracolumbar hernia as a rare cause of back pain.
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PMID:Thoracolumbar hernia: a rare cause of back pain. 925 40


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