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

Many factors seem to influence the recurrence rate after adult inguinal hernia repair. A statistical analysis of data derived from 726 transversalis fascia repairs examined by the authors (with a follow-up rate of 82.5% and a mean follow-up time of 5.5 years) revealed a significantly higher recurrence rate in patients with chronic bronchitis (p less than 0.05) or with postoperative complications (p less than 0.001). Lower recurrence rates were found after resection of lipomas of the cord (p less than 0.01) or cremasteric muscle resection (p less than 0.05). No significant difference of recurrence rate could be established for following parameters: Sex, side, age distribution, profession, prostatism, obesity, type of hernia (direct, indirect, combined, sliding), suture material (silk, polyglycolic acid), surgeon, anesthesia (local, spinal, full), elective or emergency operation, and whether the repair was unilateral or simultaneously bilateral. Recurrent repairs showed no significantly higher recurrence rate than primary repairs.
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PMID:[10 years' experience using a modified Shouldice surgical technic for inguinal hernia in adults. II. Which factors modify the recurrence of inguinal hernia?]. 355 81

Elective abdominal herniorrhaphy carries morbidity and mortality rates of 26 percent and 1.5 percent, respectively, in patients over 65 years of age. These figures climb to 55 percent and 15 percent during emergent surgery. Our purpose was to investigate if standardization of treatment could improve such results. Our program stressed centralization of care in a hernia clinic; early operation of patients at risk of incarceration; optimization of underlying systemic disorders by consultative services; operation under local anesthesia; preoperative, operative, and postoperative protocol; and continuity of care by senior personnel. Over a 4 year period, we have performed 241 abdominal herniorrhaphies in patients over 65 years of age (median age 71.5 years old) who exhibited an 84 percent incidence of significant preoperative systemic disorders. Since the inception of our program, our rate of emergent operation has decreased significantly from 7 percent to 2 percent (chi-square less than or equal to 0.05). Our rate of systemic complications after elective operation was 1.2 percent and 0 after emergent operation. These data are statistically better than those reported in the literature (chi-square less than or equal to 0.05). These results suggest that the creation of a hernia clinic significantly improves the care of herniated patients.
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PMID:Herniorrhaphy in the elderly. Benefits of a clinic for the treatment of external abdominal wall hernias. 356 84

We describe a young man who experienced malignant hyperpyrexia, probably triggered by suxamethonium and/or enflurane during his second operation for an epigastric hernia. His malignant hyperthermia susceptibility was later verified using the caffeine/halothane contracture test in vitro. Subsequently, a tumorous mass, consisting of herniated and hypertrophied muscle grew in his thigh, and was resected under spinal anaesthesia. Whereas dantrolene (2.5 mg/kg i.v.) pretreatment produced impaired swallowing, the subsequent high spinal block, in addition, resulted in laboured breathing. It is stressed that respiratory power should be monitored when patients pretreated with dantrolene are given spinal anaesthesia. The muscular symptoms and test results in the patient's relatives are also discussed.
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PMID:Spinal block, after dantrolene pretreatment, for resection of a thigh muscle herniation in a young malignant hyperthermia susceptible man. 359 Dec 54

Four hundred and seventy one inguinal hernia repairs were performed by surgeons in training as day cases using local anaesthesia between September 1979 and December 1982. All patients were sent questionnaires relating to the possibility of a recurrence or an unsatisfactory outcome of the operation at a mean of 34 months after surgery. A 96.8% retrieval rate was achieved. As a result of answers received 62 patients were examined. Nineteen recurrences (4.2%) were diagnosed by an independent assessor; a rate of 2.2% for indirect and 8.2% for direct inguinal herniae. No UK series approaches this operation frequency and none has junior surgeons as the sole operators. The recurrence rate is comparable with many in-patient and short stay series. As a result of this day unit, local waiting times for hernia repairs have dropped from 2 years to 6 weeks.
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PMID:Recurrence rates following local anaesthetic day case inguinal hernia repair by junior surgeons in a district general hospital. 360 9

Hypoplasia of the lungs is the cause of the high mortality of newborns with diaphragmatic hernia. Survival depends mainly on the development of the contralateral lung. Eighty percent of diaphragmatic hernias are postolateral hernias of the left side. The most serious postoperative complication is a relapse into fetal circulation with increased pulmonary vascular resistance and right-to-left shunting (Fig. 2). The clinical signs of diaphragmatic hernia are cyanosis and tachypnea. Intermittent suction via a nasogastric tube and early intubation without mask ventilation should be performed. The inspiratory pressure should not exceed 25 cm H2O to minimize the risk of pneumothorax. Survival of the baby is unlikely if the initial blood gas analysis shows pH less than 7.10, pO2 less than 50 mmHg, and pCO2 greater than 65 mmHg. Hypothermia should be strictly avoided because it leads to increased oxygen consumption. Intraoperative monitoring should include a precordial stethoscope, ECG, blood pressure, and rectal temperature. Anesthesia is maintained with fentanyl 0.02-0.03 mg/kg body wt. and pancuronium 0.08-0.1 mg/kg. One dose of atropine (0.02 mg/kg) is administered before fentanyl. Intraoperative ventilation is performed by hand or by use of a Siemens Servo ventilator. Thirty newborns were anesthetized for repair of a congenital diaphragmatic hernia with no intraoperative complication and an overall mortality of 27%.
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PMID:[Anesthesia for congenital diaphragmatic hernia]. 363 96

Sixteen patients receiving maintenance hemodialysis in whom moderate-to-large pericardial effusions developed were treated with short-term drainage via a large-bore tube implanted into the pericardial sac. Drainage tubes were implanted using a subxiphoid approach (subxiphoid pericardiostomy) while the patient was under local anesthesia. In seven patients, triamcinolone hexacetonide was instilled into the pericardial sac through the drainage tube at regular intervals. In all patients, a drainage period of two to four days, with or without instillation of nonabsorbable steroids, was associated with resolution of the pericardial effusion. Only one recurrence of effusion was demonstrable over a follow-up period extending from three months to eight years (median, 4.2 years). Complications of subxiphoid pericardiostomy were minor (incisional hernia, wound infection, and small pneumothorax) and easily treatable. Our results suggest that short-term drainage via a surgically implanted drainage tube is an effective and safe treatment of moderate-to-large hemodialysis-associated pericardial effusion.
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PMID:Subxiphoid pericardiostomy for hemodialysis-associated pericardial effusion. 371 97

The Shouldice repair is used for all types of inguinal hernia whether indirect, direct, sliding, multiple, recurrent, male or female. Local anesthesia is given in more than 95% of cases. The repair is a modified Bassini. Essential preliminaries are accurate dissection at the internal ring with adequate treatment of any indirect hernia. The cremaster is excised. Accurate recognition and definition of the transversalis plane is routine and fundamental. Essentially the repair is an overlap of the divided transversalis plane utilising 4 lines of continuous monofilament stainless steel wire 34 gauge. Patients, ambulant immediately, stay in hospital 2-3 days postoperatively. A large personal series of more than 20,000 inguinal repairs performed almost exclusively in this hospital during a 30 year period from 1954 to 1984 is tabulated. Recurrence rates of less than 1% for repair of primary inguinal hernia and re-recurrence rates of 2-4% for repair of recurrent inguinal hernia are reported. Surgeons in other countries now employing this technique achieve comparable results, often using other non-absorbable suture material.
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PMID:The Shouldice Hospital technique. 377 Nov 16

One goat anesthetized with thiamylal sodium, xylazine, and halothane for repair of an abominal hernia, and 7 of 29 goats similarly anesthetized for an experiment unrelated to considerations of anesthesia, developed signs of hepatic failure within 24 hours of anesthesia. Affected goats had high values for serum aspartate transaminase and serum total bilirubin by 12 to 24 hours after induction of anesthesia. Necropsy of the 8 affected goats revealed centrilobular to massive hepatic necrosis (8 of 8), brain lesions consistent with hepatic encephalopathy (3 of 4), and acute renal tubular necrosis (6 of 6). Two unaffected goats had no hepatic necrosis. Causes of hepatic necrosis other than those related to anesthesia (eg, infectious agents, toxins) were ruled out by lack of supporting necropsy findings or were considered unlikely because of lack of opportunity for exposure. Hepatic lesions in these goats closely resembled those described in human beings with halothane-associated hepatic injury, although in both species these lesions are nonspecific at the gross and light microscopic levels. The pathogenesis of halothane-associated hepatic injury in goats, as in human beings, remains to be determined.
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PMID:Hepatic necrosis following halothane anesthesia in goats. 379 99

Almost every scrotal operation may be done with local anesthesia. Occasionally general anesthesia may be elected, but the basic orientation to scrotal surgery should be with local anesthesia as long as the operation can be completed within 3 hours. The only scrotal operation for which I routinely elect general anesthesia is bilateral vasoepididymostomy because this is the only scrotal procedure that takes over 3 hours. Very rarely a scrotal hernia or a huge hydrocele obscures the cord, preventing administration of local anesthesia. Aside from these rare exceptions, I perform all scrotal surgery with local anesthesia. The use of preoperative sedation makes it possible for all patients to tolerate the small amount of discomfort associated with injection of a local anesthesic. Once the anesthetic is injected, scrotal surgery is painless. Regardless of the choice of local or general anesthesia, virtually all patients are discharged to home on the day of surgery. All scrotal surgery should be considered to be ambulatory surgery.
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PMID:Surgery of scrotal contents. 381 Oct 48

To assess the suitability of latamoxef (moxalactam) as single agent chemoprophylaxis in elective colorectal surgery, 120 consecutive patients were randomized to receive latamoxef (L) 1 g or cephazolin 1 g and metronidazole 500 mg (CM) administered intravenously at induction of anaesthesia and 6 and 12 h postoperatively. The groups were well matched for age, sex, pathology and procedures. Serum and tissue levels of latamoxef were well above the MIC90 for most bowel organisms. Inpatient stay was similar for both groups. Pyrexia was seen in 44 patients (11 L, 23 CM) and eight developed a wound infection (3 L, 5 CM). Major intra-abdominal sepsis occurred in seven patients (2 L, 5 CM), secondary to anastomotic leakage in four (1 L, 3 CM). Twenty patients developed a chest infection (5 L, 15 CM) and eight urinary sepsis (2 L, 6 CM). No bleeding complication occurred, and there was no difference in clotting function between the two groups. Six patients died prior to follow-up at six weeks (1 L, 5 CM), two from anastomotic dehiscence. All but three wounds had healed (1 L, 2 CM) and one further patient had an incisional hernia (CM). These results suggest that latamoxef is an efficient chemoprophylactic agent in elective colorectal surgery, and is marginally better than cephazolin plus metronidazole.
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PMID:Latamoxef: single agent prophylaxis in colorectal surgery. 404 62


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