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

As the mitral valvular apparatus tenses during systole, forces transmitted along the chordae tendineae to the left ventricular chamber may influence left ventricular performance. To test this hypothesis, 10 dogs anesthetized with fentanyl were studied during cardiopulmonary bypass. The importance of the mitral apparatus in left ventricular systolic function was assessed independent of load by means of the slope of the contractile state-dependent left ventricular peak isovolumetric pressure-volume relationship (Emax), which was measured at constant heart rate and aortic pressure with a micromanometer inside a left ventricular intracavitary balloon before and immediately after all chordae tendineae were severed. Herniation of the balloon was prevented by a disk secured to the mitral anulus. Emax decreased from 11.97 +/- 3.35 (+/- SD) to 6.38 +/- 0.96 mm Hg/ml (p less than .001) with chordal severing. The volume intercept (Vo) was unchanged. Fluoroscopic studies of the balloon contour in eight additional dogs revealed dyskinesia in the area of the papillary muscle insertion and substantial alterations in chamber geometry during systole after the chordae were severed. Accordingly, we conclude that global left ventricular systolic performance is impaired when chordal attachments of the mitral valve are disrupted. Changes in left ventricular geometry or loss of inward force normally transmitted to the left ventricular wall as the valve tense may underlie these changes. These findings suggest that postoperative left ventricular dysfunction after mitral valve replacement may be attributable, in part, to excision of the native mitral apparatus at the time of surgery and support efforts to spare chordae during mitral valve surgery.
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PMID:Valvular-ventricular interaction: importance of the mitral apparatus in canine left ventricular systolic performance. 369 58

A thorough explanation of vasectomy is important for couples considering male sterilization in order to distinguish it from castration and to emphasize that the male sexual organs are not the focus of surgery and that there is no change in the hormones controlling male sexual behavior. Patients should be informed of the possibility of spontaneous canalization and the uncertainty of surgical reversal. Sterility after vasectomy is not immediate and a semen analysis should be prepared after 20 ejaculations. 2 successive analyses demonstrating absence of sperm are usually considered to indicate sterility. A complete general and local examination should be performed before vasectomy. Local anesthesia may be used unless the patient is tense or has a varicocele, hydrocele, or a large inguinal or scrotal hernia, in which case general anesthesia and extended surgical facilities are needed. During surgery, the cut ends of the vas should be microcauterized. Spontaneous canalization has occurred despite removal of a section of the vas, coagulation of the lumen with diathermy, and ligation of the ends with silk after turning them back. A recent study of 40 patients showed that placing the 2 cut ends of the vas in different fascial planes did not reduce the risk of spontaneous canalization. Among complications, bruising is common but resolves within a few weeks without treatment. In 1 series, minor hematomas occured in 3-5%, .7% of which required treatment. Large hematomas can require hospitalization or surgical drainage. Infection in the scrotum is potentially serious and occurs in 1.5-4.3% of patients. Sperm granuloma formation is a complication in 20-50% of cases, but a sperm granuloma at the vasectomy site allows decompression of the vas and epididymis, assuring good quality sperm in the vas fluid and improving the prospects for future reversal. Surgery in the genital area can cause castration anxiety even in normal, well-adjusted men, but problems can be prevented by preoperative assessment and counseling. 3 factors are most important to successful reversal: meticulous surgical technique at vasectomy and anastomosis, the length of time since vasectomy, and the presence of a sperm granuloma. It has been suggested that successful reversal is more likely if the vasectomy was performed at a distance from the epididymis, not more than 1 cm of the vas was removed, and the stumps were buried in different fascial planes.
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PMID:Vasectomy. 650 43

The femoral hernia can be defined as infrequent, and predominantly found in females, with the highest incidence between 30 and 40 years of age. It shows a high tendency to strangulation, also up to 40% of cases, due to the presence of the Gimbernat ligament, which with its tense fibrous margins, aids strangling known as "raised crest". The diagnosis may not be easy, overall in the clinical presence of acute abdomen in elderly patients, disabled people or people who are uncooperative during physical examination. Therefore, it should be sought with an adequate bilateral exploration of the region in all occlused patients and especially with the use of radiological images of the small intestine. The solution currently practiced is prosthetic, proposed by Lichtenstein, and variously modified by Gilbert, Rutkow, Bendavid, and other which uses a prolene plug in the shape of a cigar, umbrella, or basket, according to the size and characteristics of the parietal defect. In emergency conditions, the technique doesn?t change; but if there is stercorary contamination, it is advisable to use direct repair according to the old method of Bassini. In the last 10 years, we have treated 37 femoral hernias in emergency, using direct repair in only 2 cases. In 3 cases we used PTFE; in the other 32 cases prolene was always used; 20 patients were operated under local anesthetic, 12 under general anesthetic and 5 under peridural anesthetic. Satisfactory results were achieved, with average hospital recovery time of 1.4 days, with an early recovery between 3 and 5 days, with only 2 relapses.
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PMID:[The femoral hernia: problems in emergency surgery]. 1706 2

We present a case of spontaneous intestinal evisceration through an umbilical hernia in a patient with alcoholic cirrhosis and long-standing ascites. Hernia rupture is an unusual and potentially life-threatening event in patients with tense ascites. Patients should be managed on an individual basis, balancing aggressive medical stabilization with the need for prompt surgical repair.
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PMID:Spontaneous bowel evisceration in a patient with alcoholic cirrhosis and an umbilical hernia. 1797 94

Spontaneous evisceration is a very rare and potentially fatal complication of abdominal wall hernia. It has been commonly reported in the case of umbilical hernia in patients with chronic liver disease with tense ascites. With other hernias, such as incisional hernia and inguinal hernia, the complication has been reported only once. Here we present a case report of spontaneous evisceration in an inguinal hernia in a patient with comorbid chronic obstructive airway disease. Management of the condition using prosthetic mesh repair risks mesh infection, while the use of non-prosthetic repair risks recurrence of the hernia due to the absence of stout natural tissues. Use of a biological mesh for the condition seems quite plausible. Thorough saline washes of the eviscerated organ, excision of redundant/unhealthy skin and strict adherence to the fundamental principles of hernia repair is desired in managing the condition.
Hernia 2011 Dec
PMID:An unusual case of inguinal hernia with spontaneous evisceration. 2067 10

Introduction. A peritoneal inclusion cyst is a very rare mesenteric cyst of mesothelial origin usually asymptomatic. A rare case of an 82-year-old white Caucasian female with a femoral hernia containing a large peritoneal inclusion cyst, mimicking strangulated hernia, is presented herein. Case Presentation. The patient was admitted to our hospital suffering from a palpable groin mass on the right, which became painful and caused great discomfort for the last hours. Physical examination revealed a tender and tense, irreducible groin mass. An inguinal operative approach was selected and the mass was found protruding through the femoral ring. After careful dissection it turned out to be a large unilocular cyst, containing serous fluid, probably originating from the peritoneum. McVay procedure was used to reapproximate the femoral ring. Histologic examination showed a peritoneal inclusion cyst. Discussion. Peritoneal inclusion cysts are usually asymptomatic but occasionally present with various, nonspecific symptoms according to their size. Our case highlights that high index of clinical suspicion and careful exploration during repair of a hernia is mandatory in order to reach the correct diagnosis about hernia's contents.
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PMID:Strangulated femoral hernia turned to be peritoneal cyst. 2321 95

The finding of the appendix inside an hernial sac is called "Amyand hernia": The global incidence is 0.28 to 1%. Clinical manifestations are the presence of an inflamed inguinal mass, tense, hypersensitivensible, with variable size, non-reducible, and associated to abdominal pain, vomit and very rarely true appendicitis manifestations. Surgical treatment depends on the case presentation and the intraoperative findings. We present a case of a giant Amyand's hernia successfully treated with surgery by performing the hernia repair with Bassini technique and transherniotomy appendectomy.
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PMID:[Giant Amyand hernia]. 2430 91

Inguinal hernia with acute appendicitis known as Amyand's hernia is uncommon. It may clinically manifest as acute scrotum, inguinal lymphadenitis, or strangulated hernia. The presentation of Amyand's hernia with acute scrotum has been rarely described. Also, the manifestation of infarcted omentum in the inguinal hernia has been described in one case previously. However, the coexistence of perforated appendix with infarcted omentum in the hernia sac which manifests acute scrotum has not been described previously. Herein, we described a case of a 5-year-old boy, admitted with right tense, painful, and erythematous scrotum in the emergency room. The diagnosis of herniated appendicitis was performed preoperatively by ultrasound. Moreover, the ischemic omentum was confirmed during surgery.
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PMID:Amyand's Hernia Complicated by Omental Infarct Presenting as Acute Scrotum: Report of a Case and Review of the Literature. 2578 21

A 59-year-old male with alcoholic cirrhosis presented to our hospital with an acutely painful umbilical hernia, and 4 mo of exertional dyspnea. He was noted to be tachypneic and hypoxic. He had a massive right sided pleural effusion with leftward mediastinal shift and gross ascites, with a tense, fluid-filled, umbilical hernia. Emergent paracentesis with drain placement and a large volume thoracentesis were performed. Despite improvement in dyspnea and drainage of 15 L of ascitic fluid, the massive transudative pleural effusion remained largely unchanged. He underwent a repeat large volume thoracentesis on hospital day 4. The patient subsequently developed a tension pneumothorax, which resulted in a dramatic reduction in the effusion. A chest tube was placed and serial radiographs demonstrated resolution of the pneumothorax but recurrence of the effusion. The radiographs illustrate the movement of fluid between the peritoneal and pleural cavities. In this case, the mechanism of pleural effusion was confirmed to be a hepatic hydrothorax via an unintended tension pneumothorax. Methods to elucidate a hepatic hydrothorax include Tc99m or indocyanine green injection into the ascitic fluid followed by its demonstration above the diaphragm. The unintended tension pneumothorax in this case additionally demonstrates bi-directional flow across the diaphragm.
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PMID:Bi-directional hepatic hydrothorax. 2853 92