Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0019270 (hernia)
 15,856 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Herniation of the hindbrain occurs when the lowest parts of the cerebellum and sometimes part of the medulla are moved downwards through the foramen magnum, a pressure difference acting across the foramen magnum moulding the tissues into a plug. It is suggested that the clinical course in both adults and babies with spina bifida may be explained by the hindbrain hernia acting as a valve.The term 'Chiari Type I deformity' is commonly used for an abnormality in which the tonsils and lowermost parts of the cerebellar hemispheres are prolapsed through a normal foramen magnum. Acute herniation may occur as a result of space-occupying lesions. Chronic herniation may be morphologically identical although it tends to be more severe. Sometimes it will produce few symptoms which often may be delayed so that the original causative lesion may not be apparent. Causes include bone softening, tumour, or previous meningitis. Birth injury is probably the commonest cause of the deformity, which presents clinically in adults.In infants with severe forms of spina bifida a hindbrain herniation is present. This abnormality may be called 'Chiari Type II deformity' or Arnold-Chiari deformity and is an intra-uterine abnormality in which the fourth ventricle and medulla are grotesquely herniated before they are properly developed and the foramen magnum is enlarged.The commonest clinical presentation of Chiari Type I deformity is syringomyelia, which is usually not diagnosed until adult life. Other presentations include syringobulbia, headache, oscillopsia, attacks of giddiness, lower cranial nerve palsies, and ataxia. Particularly characteristic are cough headache and cough syncope. Syringomyelia and syringobulbia in particular may be irreversible by the time they are diagnosed. Nevertheless, surgical decompression may be successful in relieving symptoms of headache, cough syncope, and long-tract compression; most cases of syringomyelia show some improvement and in others progression of the disease is arrested. Operative techniques for hindbrain herniation are discussed.Chiari Type II deformity is probably responsible for the progression of hydrocephalus after birth in the majority of babies with spina bifida. Measurement of pressure in the cerebrospinal fluid above and below the foramen magnum shows that intermittent pressure difference is commonly present at times of neurological deterioration. Surgical decompression of the hernia in adults allows correction of the valvular effect, which may be monitored by pressure measurements. In babies the associated hydrocephalus is usually so gross that it requires separate treatment, but pressure monitoring may be of value in assessing the state of the disease.
 ...
PMID:Chronic herniation of the hindbrain. 701 51

Simultaneous intraventricular and intraspinal pressure recordings in erect patients with obstructive lesions of th CSF pathways reveal differences in pressure which are frequently transitory and produced by pulsation. In non-acute cases without papilloedema but with suspected hindbrain hernia delay in equalization after pressure pulses may be demonstrated, and after Valsalva's manoeuvre differences between the head and the spine may be generated transiently and be responsible for clinical symptomatology. The particular clinical features related to hindbrain hernia are syringomyelia, cough headache, cough syncope, and lower cranial nerve signs with oscillopsia and cerebellar ataxia. Correction of the pressure dissociation is often associated with marked clinical improvement. It is suggested that this form of testing may be of relevance as an indication for operation and also for monitoring the progress of post-operative patients.
 ...
PMID:Simultaneous cerebral and spinal fluid pressure recordings. 2. Cerebrospinal dissociation with lesions at the foramen magnum. 731 57

We studied the effects on CSF dynamics at the foramen magnum and the clinical significance of the abnormal tonsillar motion in 14 patients with Chiari type I malformation and 14 control subjects using cine phase-contrast MRI. Dynamic MRI consisted of axial and sagittal cine phase-contrast sequences. CSF and tonsillar motion were qualitatively and quantitatively evaluated, and the subarachnoid space at the foramen magnum measured. In Chiari patients, cine phase-contrast MRI detected the abnormal pulsatile motion of the cerebellar tonsils, which produced a selective obstruction of CSF flow from the cranial cavity to the spine. The amplitude of the tonsillar pulsation and the severity of the arachnoid space reduction were associated with the symptom of cough-strain headache, but not with the presence of syringomyelia. The finding of abnormal valve dynamics of the cerebellar hernia revealed by cine phase-contrast MRI conforms to the pathophysiologic mechanisms suggested in pressure register studies and opens a new possibility in the presurgical assessment of Chiari patients with exertional symptoms.
 ...
PMID:Motion of the cerebellar tonsils in Chiari type I malformation studied by cine phase-contrast MRI. 767 39

A statistical analysis of 340 patients operated between 1986 and 1991 for inguinal hernia using the Shouldice procedure are reported by the authors. The majority of patients (60%) treated was between 45 and 65 years old. Two-hundred-eighty-one (82%) were controlled with a mean follow-up of 30 months (range 1-6 years) and was executed with physical examination and a medical questionnaire looking for recurring factors of risk. Hundred-twenty-eight patients (45% of controls) were at the high risk, nevertheless hernia recurrences were not noticed. Postoperative course was uncomplicated in 93% of patients. Early or late loco-regional complications had an incidence of 7%. Local infections and edema were reported in 10 of 22 patients. Acute urinary retention, cephalalgia and hypotension correlated with an anesthesiologic method had an incidence of 5% (17 cases). There were no deaths was pulmonary embolisms. A review of literature was performed and compared with our work. From experience in our Division, Shouldice's hospital technique had a high reliability compared to methods utilized in the previous ten years (Bassini, McNealy, Postemskj, Mugnai-Ferrari), in terms of recurrences.
 ...
PMID:[Inguinal hernioplasty by a modified Shouldice technic. Our experience with 350 treated cases]. 829 Jan 55

The development of surgery in regime of day hospital proceeds swiftly, especially in Anglo-saxon countries, so that at the beginning of the second millennium it can be foreseen that in USA alone, 75% of all surgery will be carried out in this manner. From March 1st to September 1st 1994, 100 patients were submitted to operations in ODS (One Day Surgery). We had 3 reconversions into ordinary hospitalization (3%), 2 for social-economic reasons and one for headache and vomiting due to intolerance to local anesthetics. As has been seen we have encountered no important complications, all patients were satisfied. From the analysis of our experience we have deducted useful indications that oblige us to partially modify our attitude: we want to transform our service into a free standing center where the patient can undergo preoperative exams, anesthesiologic examinations and surgery on the same day; we are just about to verify the possibility, thanks to an accurate anamnesis, to not request preoperative routine exams in patients with ASA 1 and 2 physical status; to look for a possible asymptomatic crural hernia in patients that undergo inguinal hernioplasty; we do not submit patients to ODS if they do not have assistance at home; or if they live too far from our service.
 ...
PMID:One surgical experience in regime of day hospital: considerations on the first one-hundred patients treated. 871 Apr 3

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.
 ...
PMID:[Ambulatory surgery and patients' experiences]. 918 62

A 36-year-old female was admitted with a 3-month history of headache and gait disturbance. Magnetic resonance imaging demonstrated a large tumor in the right cerebellopontine angle and syringomyelia in the upper cervical cord associated with caudal displacement of the cerebellar tonsil. Complete removal of the tumor resulted in disappearance of these associated conditions. Herniation of the cerebellar tonsil and distortion of the brain stem had probably caused disturbance of cerebrospinal fluid flow, which combined with obstruction of the spinal canal, caused the syrinx.
 ...
PMID:Cerebellopontine angle meningioma causing asymptomatic syringomyelia--case report. 930 Dec

A 43-year-old woman presented with dull headache, left tinnitus and dizziness. Neurological examination revealed down-beat gaze nystagmus, left tinnitus, positive Romberg sign, poor standing on the left foot, poor tandem gait, left spastic gait and positive pathological reflexes in the bilateral upper and lower extremities. Plain X-ray of the skull and cervical vertebrae demonstrated basilar impression and atlantoaxial fusion. Magnetic resonance imaging of the brain and cervical spine showed cerebellar tonsil descent and syringomyelia located in the left side of the spine at the II-III vertebral level which communicated with the fourth ventricle. The patient was diagnosed as having cervical syringomyelia. Arnold-Chiari type I malformation and basilar impression. Preoperative polysomnography showed dysrhythmic breathing and bradypnea during sleep. Abnormal breathing improved after suboccipital decompression craniotomy and upper cervical laminectomy. It was suggested that dysrhythmic breathing was caused by a disorder of the medullary respiratory center. Herniation of the cerebellar tonsil and syringomyelia might have compressed the medulla.
 ...
PMID:A case of Arnold-Chiari Type I malformation presenting with dysrhythmic breathing during sleep. 962 58

We described herein a case of the fulminant form of acute disseminated encephalomyelitis (ADEM) that developed after mycoplasma pneumonia. A 28-year-old man who presented with fever, headache, and writing difficulty was admitted to our hospital in August 1997. He developed hernia on the 3rd hospital day. Surgical decompression and intravenous prednisolone failed to halt his progressive deterioration. We introduced systemic hypothermia and he has shown marked recovery; despite having Broca's type aphasia, he could comprehend spoken language and communicate with others by gesture. Head MRI demonstrated diffuse high signals over the white matter on fluid attenuated inversion recovery (FLAIR) images, which suggested extensive demyelination. The clinical course, imaging studies and presence of polymorphonuclear dominant leucocytosis in the blood and CSF in the patient are somewhat similar to findings in acute hemorrhagic leukoencephalitis, however, the result of a brain biopsy was inconclusive. The fulminant form of ADEM is usually fatal. Treatments such as corticosteroids, intravenous immunoglobulin, and surgical decompression have been performed to improve the prognosis. Our case results indicate that hypothermia, which suppresses both brain edema and immune response, may be included in the repertoire of treatment for the fulminant form of ADEM.
 ...
PMID:Fulminant form of acute disseminated encephalomyelitis: successful treatment with hypothermia. 1042 55

To determine if improved postoperative recovery in surgical inpatients receiving intraoperative therapeutic suggestions are applicable in an outpatient population, 70 consenting, unpremedicated adults undergoing elective outpatient hernia repair under general anaesthesia were allocated randomly to either a therapeutic tape (TT) or a comparison tape (CT) group. A standardized general anaesthetic technique was used with propofol, fentanyl or alfentanil, isoflurane and nitrous oxide in oxygen. Pain, and nausea and vomiting were assessed after operation at 30, 60 and 90 min and at 2, 6 and 24 h. The presence of other side effects, such as headache and muscular discomfort, in addition to recall of tape contents, were also evaluated after operation. Absorption ability was measured before operation. The groups were similar in patient characteristics, preoperative, surgical and anaesthetic characteristics, and level of absorption. There were no differences in pain ratings or need for analgesics administered at any time after operation. Nausea/vomiting was experienced significantly fewer times by patients in group TT compared with group CT over the first 90 min (group CT 15%, group TT 4%; P < 0.02), but not over the last three assessment times (group CT 10%, group TT 14%; P < 0.25). The therapeutic tape group experienced fewer side effects over the entire postoperative assessment period (P = 0.03), in particular less headaches (P = 0.03) and less muscular discomfort (P < 0.02). Use of intraoperative therapeutic suggestions could present mildly significant postoperative benefits in outpatients.
 ...
PMID:Intraoperative therapeutic suggestions in day-case surgery: are there benefits for postoperative outcome? 1069 Jan 56


1 2 3 4 Next >>