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

The duration of impairment of mental functioning after anaesthesia was studied in 55 patients undergoing hernia repair who were divided into three groups in which the method of induction of anaesthesia (intravenous or inhalational) and ventilation (spontaneous or controlled) was varied. Performance in a five minute serial reaction time test and subjective estimates of coordination were assessed four times a day for two complete postoperative days and were compared with those in a control group of orthopaedic patients in hospital. After considerable impairment initially, reaction times in all groups gradually returned towards control values, but in patients breathing spontaneously during anaesthesia impairment recurred during the second postoperative day. These results suggest that such patients should be advised not to undertake hazardous tasks such as driving a car for at least 48 hours after a general anaesthetic. Discrepancies between subjective and objective assessments of impairment also suggest that patients should not rely on their own assessments of fitness to drive.
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PMID:Profile of recovery after general anaesthesia. 640 77

During a national survey of Hunter's syndrome, 52 boys with the severe form were ascertained. The average ages of onset and death were 2.47 and 11.77 years respectively. Most patients had a large head and short stature. Persistent diarrhoea was noted in 65 per cent of the patients. 76 per cent had an umbilical hernia. Right and left inguinal herniae were noted in 51 and 32 per cent respectively. Evidence of cardiovascular disease was found in 65 per cent of cases; and serious lower respiratory-tract disease occurred in 84 per cent. Induction of anaesthesia proved difficult or impossible in five boys. The disease pattern was dominated by the effects of neurological involvement, with initial developmental delay and behavioural disturbance, followed by regression, with convulsions and pyramidal tract signs. Death was due primarily to this neurodegenerative cachexia, with superimposed respiratory disease.
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PMID:The natural history of the severe form of Hunter's syndrome: a study based on 52 cases. 641 86

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

About two series of inguinal hernia, 106 operated under local anesthesia and 100 operated under general anesthesia, the authors reviewed retrospectively the local and general complications and the immediate and long-term results (1 year). The authors observed the same results in both groups; they conclude that local anesthesia can be considered as the first choice procedure in the treatment of uncomplicated hernia of high risk and geriatric patients.
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PMID:[106 inguinal hernias treated under local anesthesia]. 651 46

The continuing high mortality in congenital diaphragmatic hernia led us to study the cardiopulmonary disturbances associated with this lesion. Since these infants infrequently have right-to-left shunting in the operating room, we adopted a treatment protocol of: continuing general anesthesia in the postoperative period using fentanyl and pancuronium; cardiac catheterization postoperatively, including placement of a pulmonary artery line and a pulmonary angiogram; rapid frequency ventilation; moderate fluid restriction; and avoidance of vasodilators until other means of management had clearly failed. Fourteen high-risk infants, presenting within 6 hours of birth, were studied and compared to 17 high-risk infants, who served as historical controls. As revealed by the physiologic data acquired in the catheterization laboratory, high-risk infants divided into "Responder" and "Nonresponder" groups. Seven of 10 "Responders" actually shunted left to right during the catheterization, demonstrating a low pulmonary vascular resistance. Seven of 10 subsequently demonstrated significant right-to-left shunting at the level of the ductus and the foramen ovale, indicating the hyperreactivity of the pulmonary vascular bed. All but one was managed successfully by ventilatory adjustments and deepening of the level of anesthesia. "Nonresponders" had a fixed right-to-left shunt unresponsive to any medical or ventilatory manipulation. All "Nonresponders" died. Pulmonary angiography suggested a smaller diameter of the affected pulmonary artery compared to the main pulmonary artery in the "Nonresponders." This implies true hypoplasia resulting in a vasculature too small to accept a full cardiac output. Survival in the treatment group "Responders" was eight of 10 (80%) v seven of 14 (50%) in the control group.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The pulmonary hemodynamic response to perioperative anesthesia in the treatment of high-risk infants with congenital diaphragmatic hernia. 652 Jun 71

Standard vasectomy techniques used in India are reviewed, including indications, history, male reproductive anatomy, preoperative assessment, exam and preparation, anesthesia, surgical procedure, closure of suture, postoperative treatment and advice, and resumption of coitus. Vasectomy is the safest and most popular method of fertility control, used since the 1930s. Male genital anatomy is presented in detail with diagrams, emphasizing innervation of the vas. Vasectomy clients should be assessed to rule out diabetes, bleeding, skin disease, infection, drug sensitivity, genital tuberculosis, hernia, and anatomical defects. The author recommends local anesthesia with lidocaine or xylocaine, without the use of adrenaline. Variations in techniques of immobilizing the vas, making scrotal incisions, treating the cut ends of the vas and removing the cut segment are presented. The author recommends immobilizing the vas with Allis forceps, making a single incision and removing a 1 cm section of vas. To prevent spontaneous recanalization, it is best to fold the distal end back, and suture, clamp or cauterize the proximal end, burying it in fascia to make a barrier. Although interposing fascia between the cut ends is best, for any operator, experience improves results significantly, no matter what method is used. Of the available methods of closing the suture, nonabsorbable sutures are best if the man can return for their removal, or even better, a small incision closed only with tincture of benzoin is most practical. Generally the man is given penicillin or tetracycline. Some type of vas irrigation, such as 0.125% nitrofurazone preferred by the author, will shorten the time to azoospermic semen. 12 to 24 ejaculations are required otherwise. There is no evidence that coitus as soon as the man feels well will encourage sperm granuloma formation. Recanalization is rare. The most common reasons for failure of vasectomy are section of some other structure, or less often, recanalization. Rarely, there is an accessory vas or a viable inguinal testis. An appendix lists equipment used in the procedure.
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PMID:Vasectomy. 654 28

Two groups of six patients were studied during light general anaesthesia using 2% enflurane and 66% nitrous oxide in oxygen, combined with regional anaesthesia, for hernia and varicose vein surgery. The effects of 3% enflurane were compared with those of fentanyl 0.3 microgram kg-1 i.v., by measuring inspired flow, tidal volume, the timing of inspiration and expiration, and occlusion pressure. Three per cent enflurane decreased ventilation by 12%. Tidal volume, mean inspiratory flow and occlusion pressure were decreased in approximately equal proportions (14, 12 and 8%, respectively). The timing of breathing did not change significantly. Fentanyl did not influence tidal volume. Ventilation was decreased by 28% as a result of a 10% decrease in inspiratory flow and a marked increase in the duration of expiration by 45%. The pattern of activation of the inspiratory muscles, as indicated by occlusion pressure, was changed by fentanyl. During enflurane and nitrous oxide anaesthesia, depression of ventilation by fentanyl or increases in enflurane concentration was not by a common central depressant mechanism.
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PMID:Comparison of decreases in ventilation caused by enflurane and fentanyl during anaesthesia. 661 70

The Golden Lion Tamarin (Leontopithecus rosalia) is an endangered species of primate indigenous to the coastal rain forest of Brazil. Since 1971 a propagation and behavioral research program has been carried out on a colony of these monkeys at the Zoological Park. Several related animals have died and at necropsy have shown absence of the anterior portion of the diaphragm with a variety of abdominal viscera in the thorax. Diagnostic studies undertaken on the living members of the colony include plain chest radiographs and gastrointestinal series. Four of the animals have been found to have major diaphragmatic defects with the liver, stomach, spleen, colon, and portions of the intestine in the chest. In three of the animals so affected clinical signs of failure-to-thrive were clearly manifest, although one female born in 1968 has reproduced successfully for 8 yr with no deleterious clinical effects from the hernia. Surgical repair of the diaphragm with relocation of the abdominal viscera has been carried out in three of the animals under a combination of intravenous and intra-tracheal anesthesia. The monkeys weighed 550, 685, and 710 g, respectively. All three Tamarins have survived the operative procedure, and subsequently have shown improved clinical status. These cases have been instructive from the genetic point of view, the major anatomical defect, the type of repair necessary, and the postoperative care in small vigorous mammals. Additionally this study documents a familial factor in diaphragmatic defects in higher mammals.
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PMID:Surgical correction of familial diaphragmatic hernia of Morgagni in the Golden Lion Tamarin. 678 31

Umbilical hernia is a common finding in cirrhotic patients with ascites. Spontaneous disruption of the hernia and attendant discharge of ascitic fluid is an unusual and rarely reported complication in these patients and is associated with an overall mortality rate of nearly 30%. During the 5-year period 1977-1982, nine patients with hepatic cirrhosis and ascites were treated for spontaneous rupture of an umbilical hernia. Ascites was attributed to alcoholic cirrhosis in all cases and was present for an average of 21 months prior to rupture. In two cases, failed peritoneovenous shunts resulted in reaccumulation of massive ascites. Initial management included sterile occlusive dressings, fluid repletion, and intravenous antibiotic administration. Hernia repair was performed an average of 4.2 days after rupture. General anesthesia was used in eight cases and local anesthesia in one case. In one instance, the hernia became incarcerated and required urgent repair. Postoperative complications, including wound infection and colonic dilatation, occurred separately in two patients (22%). One patient died of hepatic failure 28 days after operation, for an overall mortality rate of 11%. Surviving patients have been followed for an average of 8 months, and most have done well. Spontaneous rupture of umbilical hernia in patients with ascites occurs uncommonly. Operative management is indicated uniformly and can be conducted safely when the patient's condition has stabilized. The prognosis is favorable for patients with good hepatic reserve.
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PMID:Management of spontaneous umbilical hernia disruption in the cirrhotic patient. 685 90

A comparative study was made regarding the complications of abdominal and vaginal sterilization operations in order to evaluate the efficacy and safety of the 2 procedures. The cases were selected from outpatient departments and family planning clinics of the Patna Medical College (Patna, India) over the 1974-79 period. A preoperative assessment and investigation were performed in all cases. The operations were performed by modified Pomeroy's technique in 300 cases (Group A) by abdominal route and in 300 cases (Group B) by vaginal route. General anesthesia was administered in all cases. Subsequent follow-up was done at intervals of 6 weeks, 3 months, 6 months, 1 year, and up to 5 years. Follow-up attendance was unsatisfactory, but a comparative evaluation of the complications was done in both groups among patients who came for follow-up. Puerperal sterilization cases were excluded from the series. In Group A 149 sterilizations were done with medical termination of pregnancy (MTP) and the remaining were interval sterilizations. In Group B 148 were sterilizations with MTP and the remaining were interval sterilizations. The age varied between 28-42 years. The majority of the patients were more than 4 para in both groups. Pelvic sepsis was more common with vaginal sterilization operations. Complications were as follows in Group A: pyrexia, 30 cases; pain in abdomen, 75; urinary tract infection, 30; sore throat, cough, 60; stitch induration, 90; and wound disruption, 3. For Group B, complications were as follows: pyrexia, 90; pain in abdomen, 30; urinary tract infection, 75; sore throat, cough, 60; tuboovarian mass, 12; wound infection, 45; and persistent temperature rise, 12. The nature of complaints at follow-up for Group A were: leukorrhea, 30; menorrhagia, 60; irregular bleeding, 30; dysmenorrhea, 12; dyspareunia, 9; loss of libido, 9; and incisional hernia, 1. Complaints at follow-up were as follows for Group B: leukorrhea, 45; menorrhagia, 21; irregular bleeding, 60; dysmenorrhea, 75; dyspareunia, 60; loss of libido, 12; abdominal pain, 12; and stress incontinence, 3. In sum, the sterilization operation by abdominal route was much safer compared to the vaginal route.
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PMID:Complications after abdominal and vaginal sterilization operation. 687 69


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