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Query: UMLS:C0019270 (hernia)
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A parallel investigation of the success of treating patients with chronic low back pain has been carried out at the Moravci Spa, at the Department for Physical Therapy and Rehabilitation and at the Rheumatology Department of Maribor Teaching Hospital. One hundred patients suffering from low-back pain were given a 14-day treatment in the termomineral water (T--36 degrees C) of the Moravci Spa. A comparative group of another 100 patients also suffering from pain in the lumbar region of the spine underwent equal balneo-physical treatment in plain water (T--32 degrees C) at the Dept. for Physical Therapy and Rehabilitation and at the Dept. of Rheumatology at Maribor Teaching Hospital, Slovenia. The educational background of the two groups features a statistically significant difference (p < 0.001): the percentage of patients with lower education was higher at the Moravci Spa (67%) compared with only 46% among those treated at Maribor Teaching Hospital. Correspondingly, the difference in occupation of the two groups were similar (p < 0.005): prevalent among the patients at Moravci Spa were bluecollar workers (40%) compared with white-collar workers (27%). The percentage of white-collar workers at Maribor Teaching Hospital was 45%. The average age of the patients treated at the Moravci Spa was 46.9 +/- 9.5 years (28-77 years), at Maribor Teaching Hospital it was 45.2 +/- 8.2 years (26-71 years). There was no statistically significant difference in age (p < 0.10) between the two groups. Generalized spondylochondrosis was present in both groups, i.e. 87%; approximately 10% of the patients from both groups underwent surgical treatment of hernia disci.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Results of a comparative study of the success of treatment of pain in the lumbar spine at the Moravske Toplice health spa, at the department of physical therapy and rehabilitation and at the department of rheumatology of the Maribor Teaching Hospital]. 136 51

Since 1983, the authors encountered 270 cases of lumbar disc hernia, which were operated on with the microsurgery. In the present study, the operative procedures were described and the results, especially the results of the reoperations were examined. Good results were obtained in 252 patients (93%). In nine patients, some kind of lumbago continued, which required other treatments, such as epidural block (3.3%). Reoperations were performed in nine patients (3.3%). In lumbar discectomy, extent of removal of the bony structures and the disc material seemed important. In "microlumbar discectomy", which was advocated by Williams, only the flavectomy with no bony structure removal was performed. In this procedure, discectomy is limited to the protruded disc material. On the contrary, some authors, who also adopt microsurgical lumbar discectomy as Wilson and Hudgins do, perform subtotal removal of the disc material with removal of some bony structures. In the present series, microsurgical lumbar discectomy following the procedures advocated by Wilson et al was performed. Reoperations after lumbar discectomy have been reported after all kinds of operations. In the present series, the rate of reoperation was 3.3%. As to the reasons for reoperations, true recurrence of disc hernia was the most prevalent. The hernias recurred at the same level and on the same side. Adhesion or fibrosis around the nerve root also played an important role. From the results of the present study, microsurgical lumbar discectomy with good illumination and high magnification has proved to bring satisfactory results. Recurrence, however, can occur after this procedure, so further inventions are required to ensure more satisfactory results.
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PMID:[Clinical analysis of 270 cases of microsurgical lumbar discectomy]. 185 49

Previous history, clinical findings, course and therapeutic outcome in 149 elderly patients with lumbar disk hernia were analyzed and compared with younger adult patients. 21% of all patients with lumbar disk hernia undergoing surgical treatment, and 25% under conservative treatment, were aged over 60 years. In these patients no history of low back pain is present in one third, the course is prolonged and motor deficits are more often encountered. Concomitant osseous narrowing (spinal stenosis, narrowed recessus lateralis) were present in 72% of this elderly group. Surgical complications are increased (34%) and are due to age-related diseases. Functional results are excellent after both conservative treatment and surgical therapy.
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PMID:[Incidence and characteristics of lumbar disk hernias in older patients]. 239 94

Posterior pre-marginal disk hernia, a rare lesion, was diagnosed in six young adults with lumbago. Lateral lumbar spine radiographic images showed an unusual appearance, combining a posterior marginal defect of a vertebral corner and a small bony spicule projecting into lumbar canal. A literature review revealed 27 similar cases, mostly in adolescents. These vertebral disk anomalies are considered by some authors to be fractures of the posterior margin border. A more plausible hypothesis is a pre-marginal hernia, because of lack of a history of injury, the radiologic appearance comparable with that of sequelae of Scheuermann's disease, and the frequent association of these lesions with a spinal growth dystrophy.
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PMID:[Isolated posterior pre-marginal hernia. Apropos of 6 cases]. 297 80

Clinicopathological studies of four cases of chronic progressive leukoencephalopathy with systemic arteriosclerosis are reported. Two patients were siblings. In all of our patients, the illness began in early adulthood (25-29 years of age), with gait and speech disturbance as the first symptoms. At about the same time, the patients complained of lumbago, caused by intervertebral disc hernia, and had a tendency toward baldness. They gradually developed disturbance of memory, dementia, spastic paraplegia, and positive pathological reflexes. After a few years, they could neither stand nor walk and became decerebrate. Blood pressures ranged from 120/60 to 140/80 mm Hg. Laboratory data were within normal limits, including serum cholesterol. EEG showed a generalized slowing. The illness ended in death after 9 years in one case and 3-4 years in the other three cases. A general autopsy was done in three cases and only the brain was autopsied in one case. The visceral organs and the brains were fixed in 10% formalin for macroscopic and histological studies. The general autopsies revealed arteriosclerosis in the small arteries of the heart, spleen, and kidneys in three cases and in addition, moderate arteriosclerosis of the coronary arteries in one. Remarkably uniform changes were found in the brains of all four cases, involving diffuse demyelination of the cerebral white matter, with some preservation of U-fibers, and small cystic and softening foci in the white matter and the basal ganglia. The cytoarchitecture of the cerebral cortex was well-preserved. The degeneration of the white matter was caused by arteriosclerotic changes of the small arteries: fibrous intimal proliferation and hyaline degeneration and splitting of the internal elastic membrane.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Chronic progressive leukoencephalopathy with systemic arteriosclerosis in young adults. 405 57

The author presents his results on 70 patients under treatment of low back pain by means of electrocoagulation of the posterior ramus of spinal nerves. In many cases of disc hernia it was possible to attain good results that enabled us to abandon the operative procedure. The best results were achieved in cases of sciatalgic pains, which were diminished more considerably than the local lumbosacral ones. When conservative methods fail, and no absolute operative indications exist, coagulation may be helpful in pain relief.
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PMID:[Percutaneous electrocoagulation of posterior ramus of spinal nerves in pain relief treatment of spondylogenic low back pain (author's transl)]. 645 58

In a North West England community of 4880 males, data were examined from 40 adult males on a general practice list who chose to be sterilized. The most popular age for vasectomy was 30-34 years; there was a sharp drop after age 40. Olny men with children were vasectomized, with average number of children per family 2.53. There were no professional men in the group but may semi skilled and skilled workers, a reflection of the industrialized area. In contrast to other reports, the results indicated that men of the lower classes are choosing to be sterilized whereas previously the professional and skilled workers represented the majority of those undergoing vasectomy. There is no evidence that vasectomy significantly effects general health. 75% of the group studied saw their general practitioner, on average, once every 3 months after the operation. 2 patients have been admitted to the hospital since their operation, 1 for arthroscopy and lateral release of the left patella and the other for hernia repair. There has been 1 case of marital breakdown and 2 cases of psychological disorder. 3 patients have suffered from recurrent low back pain which is probably related to their weight problems and occupation. Nearly 60% of the people in the study completed and returned their questionnaires. The success of the counseling technique was reinforced by the fact that 95% thought that enough information was given. The effectiveness of the operative procedure is shown by the 100% success rate of sterilization. 74% of the men required only 3 days or less off work; 23% required some treatment or advice from their general practitioner subsequent to the operation. Only 9% found the procedure more painful than expected. All the men would recommend the operation and were glad to have had it done. 40% reported better relationships with their wives.
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PMID:A survey of vasectomised patients. 646 16

A patient with unexplained low back pain, weight loss, and pulmonary infiltrate underwent an inguinal herniorrhapy. Histologic examination of the grossly normal hernia sac revealed metastatic adenocarcinoma. The patient died of cachexia 10 months later. This case observation suggests the necessity of histologic examination of grossly normal hernia sacs.
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PMID:Metastatic carcinoma in inguinal hernia sac. 671 21

The psychosocial backgrounds were examined in patients making only slow recovery after lumbar disc hernia operation without organic cause, in patients with recurrent low back pain syndrome, and in a control group of healthy persons. These three groups of persons were employed as skilled or unskilled laborers. For the purpose of the study a self administered questionnaire (MISREP) was completed by the patients. This included psychological, medical, social, and sociological factors. The specific answers obtained were examined by means of statistically relevant methods to determine the difference between the three groups. The disc operation patients and the low back pain patients showed different attitudes to some specific questions. These concerned career prospects, early retirement, subjective assessment of overwork, frequency of illness, negative work conditions, job satisfaction, readiness to be retrained for a suitable job, relations with superiors and co-workers, positive expectations of medical treatment, various symptoms from the vegetative and somatic fields, and symptoms of depression and introversion. The information showed the control group to be most significantly different by a lower readiness for conflict and circumstances less characterized by conflict. The possibility of a specific personality structure is discussed in general and in detail.
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PMID:[Psychosocial studies in patients in a condition after intervertebral disk surgery]. 688 Apr 12

The authors present 46 cases studies of herniated lumbar discs treated by chemonucleolysis in the previous 2 to 9 months. One patient suffered from recurrent acute lumbago; the other 45 patients suffered from lumbar root pain. The diagnosis of herniated disc was confirmed by radiography of the lumbar roots. Chemonucleolysis was performed under neuroleptanalgesia in the majority of cases, after failure of medical treatment and as an alternative to surgery. The patient treated for recurrent lumbago obtained a good result. After one month, 20 patients no longer suffered from sciatica and two had only a mild and intermittent sciatic pain. The results are lasting. Overall, chemonucleolysis is successful in 69% of cases. The success rate decreases with the age of the patient and the age of the symptoms. The results appear to be unchanged by the number of discs treated, their level or their discographic features. The results appear to be unchanged by the number of discs treated, their level or their discographic features. The results seem to be better when the disc being treated has not collapsed and when the hernia is not too large. Seven failed cases went to operation when, in each case, a non ruptured herniated disc was found. In 4 cases there was minimal tissue and in 2 cases the hernia was soft. The tolerance was excellent. Chemonucleolysis is effective in the treatment of herniated lumbar discs, but should be reserved for selected patients. Used with care, the treatment is safe. In cases where the treatment fails, the surgical procedure is not interefered with.
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PMID:[Treatment of lumbar disk hernias using chemonucleolysis]. 718 28


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