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

A semiologic study is performed and therapeutic proposals are made on the basis of the anatomical and physiopathological data relating to residual neuralgia after the cure of a hernia. A series of 47 patients, 41 of whom were treated at the Multidisciplinary Pain Treatment Center of Avicenne Hospital (Bobigny) is analysed. The results are the following: 16 cures, 22 improvements, 6 failures, 3 patients lost to follow-up. The authors emphasize the difficulties of treatment, the poor effectiveness of second surgery as a rule, and the necessity of a general management.
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PMID:[Treatment of neuralgia after surgical repair of inguinal hernia. Apropos of 47 cases]. 177 58

The authors propose a technique of fixation of the parietal prosthesis by metallic staples in order to reduce the operation time which is often long. The operation was performed according to J Rive's principles, using a Dacron patch (n = 65) or a polyglactin patch (n = 5). A mechanical stapler for aponeurotic suture was used for fixation of the patch. The bent shape of the stapler made it possible to very easily insert the lateral edge of the patch, previously hemmed, to slip it under the rectus abdominis muscle and to clamp it onto the lateral linea alba. We placed the patch under tension very easily with circular clamping. Seventy ruptures were treated by this technique. In 80% of cases, the rupture was frontal and in 20% of cases, it was fronto-lateral. The mean diameter of the parietal defect was 15 cm (E = 10-35 cm). The time for fixation of prosthesis was less than 5 min; the usual duration of the operation was therefore considerably reduced. In every case, we obtained optimal tension of the suture, without any folds, and this very easily. There was no mortality. Two postoperative hematomas, one consecutive to an injury of the epigastric artery required a second operation. We only had one case of superficial parietal sepsis. None of these complications required removal of the parietal prosthesis. The functional results were always satisfactory for the patients who suffered no pain induration over the metallic staples. A radiological follow-up of the position of the prosthesis encircled by the metallic staples was systematically performed after every operation. Only one relapse, due to a technical error, was observed. If we consider that the follow-up of these results is about two years (3 months-5 years), they suggest that the use of a stapler allows strong fixation, without any fold and with a regular tension, of the prosthetic patch used in the treatment of large incisional hernia. If we compare this technique with the usual techniques of fixation, we can say that this technique significantly reduces the duration of the operation which is often long. These technical advantages help to reduce the long operating time and the risk of sepsis, which is always serious, also minimizing recurrences of the rupture.
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PMID:[Method for the correction of ventral hernia using a parietal prosthesis held by a metal stapler. Apropos of seventy cases]. 178 9

Questionnaires were sent five years postoperatively to all patients between 15 and 80 years old at operation who were treated for inguinal or femoral hernia in 1984 at Motala Hospital. Patients were asked about pain or a lump in the operation area and a clinical examination was offered. Of 137 patients with 142 hernias, 92% answered the questionnaire and 88% came to the examination. Among patients who answered the questionnaire and attended the examination the cumulated recurrence rate was 19%, when recurrence was defined as an indication for reoperation or a bulge in the operation area that appeared or increased during abdominal straining. Predictive values for positive and negative questionnaire answers in relation to hernia recurrence were 69% and 95%, respectively. In 14% of hernia operations a reoperation had been performed or was needed. Testicular atrophy was found in 2.7% of male patients. A questionnaire follow-up may be appropriate for identifying patients with symptomatic recurrencies, but it is inadequate as a single indicator of quality assessment in hernia surgery.
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PMID:Quality assessment in hernia surgery. 178 88

Ninety-one patients underwent a repeat CT examination 2-3 months after chemonucleolysis. In 39 patients the size of the herniation was unchanged; no correlation could be found between the CT examination and the clinical results. One year after chemonucleolysis, 27 of the patients underwent a third CT examination. The majority of the scans revealed a reduction of the herniation, while 16 of the patients still had a hernia. No correlation could be found between the clinical results and the CT examination. We conclude that a repeat CT examination after chemonucleolysis does not permit evaluation of patients with persistent or recurrent radicular pain.
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PMID:CT examination of 91 patients after chemonucleolysis. 182 83

The work is based on the analysis of the results of surgical treatment of inguinal hernias in 198 patients in the period from 1983 to 1988. Most of the patients were over 60 years of age, a lesser number were under 35 (11.1%). Hernias of a complicated and transitional form were found in 174 patients and mild forms only in 24 patients. The hernias were recurrent in 45 and sliding in 59 patients. Proceeding from the specific features of the surgical anatomy of the inguinal space, all patients, irrespective of their age and the form and type of the hernia, were treated by operation with plastics of the opening of the hernial sac to the back of the elements of the spermatic cord. The only exception were patients under 35 years of age with a mild form of oblique inguinal hernia, in which case variants of operations with enforcement of the anterior wall of the inguinal canal were carried out. The Schouldies and McVay methods were preferred, in recurrent and all complicated forms of inguinal hernias they were combined with operations of the Endrews and Postempsky types; the last named was mostly used in individuals over 60 years of age and in repeatedly recurring hernias. The late-term results were studied in follow-up periods of 2 to 7 years in 176 patients in the group of 198 individuals who were operated on. In 77.7% of them 3-6 years have passed since the operation. Almost all patients of mature age have resumed their occupation, there are complaints neither of pain at the site of the operation nor of changes in sexual potency. Recurrent hernias were not detected.
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PMID:[Principles of surgical treatment of inguinal hernia]. 182 82

Hernia of the lung manifests itself as an elastic, usually replaceable, swelling in the chest wall, which changes in size during inspiration and expiration. It does not generally cause any symptoms. We describe the case history of a 49 yr old man with an acquired thoracic lung hernia, which had first presented three years previously as pain in an operation scar during coughing and lifting. Histopathology of the excised lung tissue showed abnormalities suggestive of previous episodes of strangulation.
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PMID:Pain in scar as an early symptom of acquired thoracic lung hernia. 185 81

Nurses who care for infants and children undergoing thoracic surgery must function and make decisions which take into account a multiplicity of complex data. This necessitates a background of knowledge, skill and intuition which guides their nursing practice. The principles of holistic care in which the total needs of the infant and child are met within the context of the family are seen as an important approach to patient care. Selected perspectives in the care of infants with congenital and acquired thoracic anomalies are discussed, in particular infants with congenital diaphragmatic hernia and oesophageal atresia. The preparation of children for chest surgery and the postoperative nursing management are outlined and include aspects of pain management, physiotherapy and chest drain care.
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PMID:Nursing perspectives in the management of infants and children requiring thoracic surgery. 190 87

237 Shouldice operations with resection of the cremaster muscle from the Department of Surgery of the RWT University of Aachen were compared with 153 Shouldice repairs without resection of the cremaster muscle from the Department of Surgery of the Elizabeth Hospital in Essen. The aim of this prospective controlled trial was to determine the value of the resection of the cremaster muscle in Shouldice's hernia repair. A comparable follow-up of 12 to 26 months in both groups revealed no significant differences in early-postoperative complications. In the group without resection of the cremaster muscle the incidence of chronic inguinal pain was reduced. However, avoidance of the cremaster resection is not advisable because it leads to atypical indirect recurrences and totally higher recurrence rate (2.6%), so four indirect recurrent hernias were diagnosed. In the group with resection of the cremaster muscle no indirect recurrent hernia was detected, only one direct recurrent hernia was documentated. The significantly elevated rate of recurrent hernias (p less than 0.05) and the occurrence of atypical indirect recurrent hernias in the group without resection of the cremaster muscle demonstrates the important influence on the technique of repair. Based on our results the resection of the cremaster muscle is an essential part of Shouldice's hernia repair.
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PMID:[Controlled study of cremaster resection in Shouldice repair of primary inguinal hernia]. 192 90

Paraesophageal hiatal hernia accounts for only five per cent of all diaphragmatic defects but is a potentially dangerous lesion. Herniation of the entire stomach, at times accompanied by the omentum, transverse colon, and small bowel, may occur in some patients, and incarceration and strangulation may be the result. Three patients underwent repair of large paraesophageal hernias, in one instance as an emergency. Symptoms of pain, bloating, and occasional regurgitation had been present for 17, 30, and 40 years. The operations included repair of the hiatal defect, anterior gastropexy, and Nissen fundoplication in two patients. In the third patient, a pyloromyotomy was performed as well. A subsequent thoracotomy was necessary in one patient to excise a persistent large hernia sac, which was densely adherent to the lung and mediastinal structures. All patients were asymptomatic after periods of 9 months, 1 year, and 7 years. The unique anatomic and clinical features of large paraesophageal hernias containing intrathoracic abdominal viscera, as well as the technique of operative repair, are presented.
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PMID:Repair of large paraesophageal hernia with complete intrathoracic stomach. 192 81

We describe a case of delayed presentation of traumatic intrapericardial diaphragmatic hernia associated with cardiac tamponade. A 71-year-old woman presented to our emergency department complaining of epigastric and midabdominal pain one month after hospitalization for multiple injuries suffered in an automobile accident. Chest radiograph showed a diaphragmatic hernia. In the ED, the patient became hypotensive and tachycardic with elevated central venous pressure. At surgery, she was found to have omentum and transverse colon herniated into the pericardial sac causing cardiac tamponade. The defect was repaired, and her postoperative course was uncomplicated. Cardiac tamponade should be included in the differential diagnosis of hypotension in patients with radiographic evidence of diaphragmatic hernia.
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PMID:Delayed traumatic intrapericardial diaphragmatic hernia associated with cardiac tamponade. 195 15


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