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

The number of elderly patients is increasing in all countries. It is estimated that about half of those over 65 will require an operation at some time, most commonly for cataract, prostatic hypertrophy, hernia, gallstones or fractured hip. Whilst overall morbidity and mortality is considerably increased in this age group, it does not appear to result from an increased liability to surgical complications, but rather to the complications of old age itself. The fundamental factor of ageing is a decreased capacity for adaptation, and this applies to virtually all organs and systems. Surgeons and anaesthetists must make allowances for these changes. Most important are cardio-respiratory limitations and altered pharmacokinetics and pharmacodynamics affecting drug action and elimination. These will be discussed in relation to the perioperative period. Once these are understood there should be no hesitation in accepting elderly patients for any form of surgery, provided the likely benefits outweigh the increased risk. Much discomfort in old age can be alleviated by a careful choice of surgery.
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PMID:Perioperative problems in elderly patients. 368 1

The morbidity and image quality after administration of three different contrast media were compared in 229 patients referred for herniography. Sixty patients received metrizoate 150 mg I/ml, 92 received metrizoate 200 mg I/ml, and 77 patients, ioxaglate 200 mg I/ml. Patient discomfort was single-blindedly assessed based on an arbitrary verbal rating scale. The number of patients with pain increased with the osmolality of the contrast media. Metrizoate 200 induced pain in 57% of the patients, metrizoate caused pain in 39%, and ioxaglate 200 in 18%. Hernia patients who received metrizoate 200 had pain significantly more often (72%) than patients without hernia (45%). Seven patients, predominantly young men, had a vasovagal reaction associated with the administration of contrast media. The image quality was sufficient after all injections of 200 mg I/ml. The results indicate that low osmolality contrast media with an iodine concentration of about 200 mg I/ml are well suited for herniography.
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PMID:Herniography: comparison of morbidity and image quality after use of high and low osmolality contrast media. 371 Jul 42

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

Herniation of the bladder has been primarily described in association with inguinal and femoral hernias. Review of the literature yielded only one case report of incisional bladder hernia. The authors report three cases of herniation of the bladder through a postoperative fascial defect. All patients presented with nonspecific sensory lower urinary tract symptoms, pelvic discomfort, and urinary incontinence. Involuntary urine loss as related to bladder hernia has been mentioned only circumstantially. Although urodynamic evaluations were performed, the mechanism of urinary incontinence could not be clarified. Cystography was essential in arriving at a definitive diagnosis.
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PMID:Incisional bladder hernia and urinary incontinence: report of three cases. 397 79

After repair of incisional hernia, 154 patients were followed up for periods ranging from 4 to 10 years. An actuarial analysis showed a cumulated recurrence rate of 31%, with most recurrences appearing in the first three years. The recurrence rate after repair of recurrent incisional hernia was 44%. A cautious attitude to surgical treatment of incisional hernia is suggested if the patient has only mild discomfort.
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PMID:Long-term results after incisional hernia repair. 401 99

The definition of soft disc hernia of the cervical spine is not always clear, so we have studied 34 cases where soft disc material was extruded or had migrated outside the intervertebral space. There were 22 cases of the paracentral-central type and 12 cases of the posterolateral type. The diagnosis was made by discography using anteroposterior, lateral and both oblique radiographs. All the patients complained of pain or discomfort in the neck or the interscapular region which was increased by the neck compression test and reproduced during discography. Severe pain in the area was present in all the cases of the posterolateral type and in about half of the paracentral-central type. Cord signs, such as increased reflexes in the lower limbs, were found in 15 cases of the paracentral-central type and in 5 cases of the posterolateral type. These signs correlated with the width of the spinal canal and the amount of prolapsed disc material. Discography and reproduction of pain were most useful for the diagnosis of this type of hernia. It has now become possible to differentiate the paracentral type from the central type by performing computerised tomography scanning after discography. We treated 12 cases conservatively and 22 cases surgically, and obtained good results in both groups.
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PMID:Soft disc herniation of the cervical spine. 401 67

Despite the widespread use of antibiotics, surgical wound infections continue to cause patient discomfort and drain on health care finances. More serious local complications often develop concomitantly (eg, cellulitis) or later (eg, incisional hernia). Inadequate treatment of an illness or poor host defenses may lead to serious systemic complications (septicemic shock, multiple organ failure). Therefore, it is essential that every effort be made to minimize the likelihood of infection. The Centers for Disease Control in Atlanta convened a group of physicians and surgeons knowledgeable in the practice of infection control. This group developed a set of guidelines that is thought to reflect the state of the art in 1982. The trials, which were objective and preferably randomized or even blinded, determined present options for surgical infection control.
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PMID:Guidelines for prevention of surgical wound infection. 661 4

The plastic quadrilateral socket has a high anterior brim which can cause considerable discomfort in some patients, especially when seated. A simple modification to the anterior brim is described allowing a female patient with a huge abdominal hernia a considerable degree of comfort when both sitting and standing. The creation of a large radius producing a wide area for adequate pressure relief proved valuable. This might be considered for patients with less pendulous abdomens who find conventional methods inadequate.
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PMID:Technical note--modified above-knee socket to relieve anterior pressure caused by abdominal hernia. 685 53

A case report of a congenital posterolateral diaphragmatic hernia in an adolescent is presented and a technique for thoracoscopic repair of Bochdalek hernia is described. Postoperative discomfort was minimal and the hospital stay was less than 24 hours. Video-assisted thoracic surgery may be the technique of choice for repair of certain congenital diaphragmatic hernias when identified after infancy.
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PMID:Video-assisted thoracic surgical repair of a foramen of Bochdalek hernia. 764 17

For uremic patients on continuous ambulatory peritoneal dialysis who are complicated with peritonitis, hernia or burn out of meticulous procedure, automated peritoneal dialysis (APD) is a new alternative therapy. We started our APD program by continuous cyclic peritoneal dialysis (CCPD) method from October, 1991 and this study included 3 CAPD patients. Our studies showed high dose CCPD was better than CAPD in ultrafiltration and urea clearance with similar weekly creatinine clearance and weekly KT/V urea. During the one year treatment course, there was no signs of fluid overload. We performed once to twice day time exchange by low volume dialysate (1500-1600ml) There was no events of abdomen discomfort due to increase intraabdominal pressure or recurrent hernia in susceptible patient. The decrease in day time exchange frequency obviously reduced patients'loading. One patient changed to high dose CCPD due to underdialysis after stand CCPD therapy. Two patients returned to hemodialysis due to severe peritonitis and technique method, but careful assessment of dialysis adequacy with PET test and KT/V evaluation is mandatory.
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PMID:[Clinical experience of automated peritoneal dialysis]. 785 Jun 57


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