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

Surgical intervention is usually indicated in reflux esophagitis when medical therapy fails to control symptoms. Since most patients with peptic esophagitis also have a sliding hiatal hernia, early procedures focused on hernia repair. Weakness of the lower esophageal sphincter is now known to be the pathogenetic mechanism, and Belsey, Nissen, and Hill have developed operations to restore sphincteric function. The Hill repair is used most often because of its low incidence of side effects, but the other procedures are recommended in specific situations. Stricture, the most common complication of reflux esophagitis, presents a special problem in treatment because interference with swallowing is added to the characteristic symptoms of reflux. Because of its high long-term success rate, the combined Thal-Nissen procedure is preferred to forceful dilation plus an antireflux operation.
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PMID:Surgical treatment of reflux esophagitis and stricture. 83 90

Peristomal herniation represents the second most common late complication of abdominal wall enterostomy. Early herniation results from the creation of too large of a fascial defect. Late herniation is caused by a gradual enlargement of the fascial defect because of a poor selection of the colostomy site or an intrinsic weakness of the fascia due to the patient's age or general condition. Once peristomal herniation occurs, operative repair should be considered in an otherwise healthy person. Previous reports advocate primary repair of the herniation. In the present series of nine patients, three patients developed recurrence of the hernia six to eight months after primary repair. Six patients had colostomy hernia repairs that involved moving the site of the original stoma. All of these repairs remain intact at an average of two years, nine months (range, four months to six years). We therefore believe that the solution to the problem of recurrent colostomy herniation lies in the transposition of the site of the original colostomy.
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PMID:Repair of peristomal colostomy hernias. 120 Feb 83

In groin hernia surgery pre-peritoneal prosthetic repair is a valid alternative to traditional inguinal repair in patients with a large area of transversalis fascia weakness: direct, inguinoscrotal, recurrent, bilateral hernias. Pre-peritoneal prosthetic surgical approach by Rives' technique (little unilateral prosthesis) has been used in 121 cases (24% bilateral and 67% recurrent hernias) and by Stoppa's technique (great bilateral prosthesis) in 95 cases (26% bilateral and 55% recurrent hernias). The results demonstrated 9.9% morbidity and 5.7% recurrences by Rives' technique vs 3.1 morbidity and complete absence of recurrences by Stoppa's technique. These results confirm the validity of large prosthetic pre-peritoneal repair in groin surgery.
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PMID:[The surgical treatment of preperitoneal inguinal hernia: a comparison between the methods of Rives and Stoppa]. 138 58

A new procedure in the surgical treatment of large incisional ventral hernias is described. It is based on the use of enlarged relaxation incisions of the abdominal fascia on both sides of the hernia to perform a direct suture of the posterior and superficial fascial layer of the hernia defect without tension. Extensive fascial defects after enlarged side relaxation incisions should be reinforced to prevent a weakness of the ventral abdominal wall. The best material may be a resorbable knitted mesh.
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PMID:A new procedure in the surgical treatment of large incisional ventral hernias with the use of Dexon Mesh. 146 35

Intermittent clinical manifestations, the representative one of which is claudication, can be classified into two types; neurogenic and vasculogenic. Although cauda equina lesions are well known as a neurogenic cause, spinal disorders, especially cervical or thoracic cord lesions, have been paid more attention to by several authors recently. We encountered a 42-year-old man with cervical soft disc hernia and ossification of longitudinal ligament, who showed intermittent rectal dysfunction evoked by walking. This peculiar clinical manifestation successfully disappeared after surgical decompression of the spinal cord. Such an interesting case has not been reported in the world literature. The patient was admitted because of numbness in both hands. Neurological examinations on admission showed neither motor weakness nor abnormally increased tendon reflex. Hypesthesia and hypalgesia were noticed below the Th4 dermatome on both sides. Adding to those symptoms, he complained of fecal incontinence evoked by walking 100 meters. This rectal dysfunction became gradually worse. At last he showed fecal incontinence after walking only 10 meters. This was ten days after his admission. Myelogram and computed tomographic scan revealed a cervical soft disc hernia at the C5/6 level and findings of OPLL at the C5 and C6 level. Anterior cervical approach for OPLL and soft disc was used for bone graft insertion from the C4 to the C7 vertebral body. The rectal dysfunction completely disappeared after the operation. The possible mechanisms of intermittent rectal dysfunction evoked by walking were discussed.
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PMID:[A case report of cervical disc hernia presenting fecal incontinence evoked by walking; spinal intermittent rectal dysfunction]. 157 69

Weakness in the musculotendinous barrier of the abdominal wall leads to inguinal herniation. Fiber degeneration by increased metabolism has been described recently as a causative factor. In previous investigations heightened elastase was detected in abdominal aneurysms. In order to investigate a possible relationship between hernias and abdominal aneurysms, patients scheduled for infrarenal aneurysm repair were examined for history of inguinal hernia. The prevalence of inguinal hernias (n = 49; 41%, p less than .001) in 119 patients with abdominal aneurysms was significantly elevated, compared to 81 patients with aortic occlusive disease (n = 15; 18.5%) and 298 patients with coronary artery disease (n = 54; 18.1%). Additionally, the number of patients with recent hernia repair (n = 19; 16%) or still awaiting repair (n = 11; 9%) was very high in the patient group with abdominal aortic aneurysms. Smoking habits were not different among all groups. We conclude that the prevalence of inguinal hernias in patients with abdominal aortic aneurysms is high compared with those with peripheral arterial occlusive disease or coronary atherosclerosis. These findings indicate a systemic fiber degeneration.
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PMID:High coincidence of inguinal hernias and abdominal aortic aneurysms. 159 30

Direct inguinal hernias occur in newborn babies, both term and premature. Five cases are reported to illustrate three types of direct hernia. The first is a direct weakness without associated significant indirect hernial sac; the second, a sliding direct hernia. The third might be called a 'secondary' direct weakness resulting from a primarily indirect hernia which assumes such large size and develops such a wide neck at the internal ring that the posterior wall of the inguinal canal is stretched and weakened. This is most likely to occur in very low birthweight babies, who develop giant inguinoscrotal hernias. Full exploration and repair of the posterior wall of the inguinal canal should be performed in such babies with huge indirect hernial sacs and in all babies where the size of the processus vaginalis identified at the internal ring is not consistent with the hernial swelling identified clinically. Repair should be performed in conventional manner with non-absorbable sutures reinforcing the transversalis fascia. Overlying Bassini repair with or without Tanner's slide can be performed. The repair should be carried out before the baby leaves a high dependency area.
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PMID:Direct inguinal hernias in the newborn. 199 90

Caudal epidural anesthesia has become widely accepted as a means of providing postoperative pain relief and intraoperative supplementation to general anesthesia for children. To determine the best concentration of bupivacaine for combined general-caudal anesthesia in children, 122 children aged 1-8 yr scheduled for outpatient inguinal herniorrhaphy were randomized to receive, in a double-blind fashion, caudal anesthesia with bupivacaine in one of six concentrations (0.125, 0.15, 0.175, 0.2, 0.225, or 0.25%). After incision, a programmed reduction in inspired halothane resulted, if tolerated by the subject, in an inspired halothane concentration of 0.5% 10 min after incision. End-tidal halothane concentration at hernia sac ligation for subjects receiving 0.175% bupivacaine (0.55 +/- 0.03%) was less than that for subjects receiving 0.15% bupivacaine (0.75 +/- 0.05%; P less than 0.05). Subjects receiving 0.175% bupivacaine also were discharged earlier from the postanesthesia care unit (PACU) (27 +/- 1 min) than were subjects receiving 0.15% bupivacaine (38 +/- 5 min; P = 0.05). Children receiving greater than or equal to 0.2% bupivacaine tended to complain more of leg weakness after surgery; however, the difference did not reach statistical significance (39 of 67 vs. 16 of 47; P = 0.057). The incidence of complaints of leg weakness and paresthesia was positively correlated with bupivacaine concentration (r = 0.706; P = 0.05). Subjects receiving 0.125% bupivacaine had higher pain scores on arrival to the PACU than did those receiving 0.2% bupivacaine (P = 0.05); there were no other differences in pain scores.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Optimum concentration of bupivacaine for combined caudal--general anesthesia in children. 206 61

A lumbar hernia usually involves protrusion of extraperitoneal fat or bowel through an area of weakness in the posterolateral abdominal wall bounded superiorly by the 12th rib, inferiorly by the iliac crest, posteriorly by the erector spinae muscle, and anteriorly by the posterior border of the external oblique muscle. Most are due to an acquired nontraumatic or congenital cause. Acute blunt abdominal trauma is a rare cause of lumbar hernia; to our knowledge, the CT diagnosis of this variety has not been reported. Since 1985, approximately 850 patients have undergone emergent abdominal CT for evaluation of acute abdominal trauma at our hospital; in seven of these patients, a traumatic lumbar hernia was diagnosed prospectively. In three patients, CT showed a flank hematoma with herniation of bowel through the lumbar triangle. CT showed pelvic fractures in three other patients, accompanied by herniation of bowel in one patient, herniation of extraperitoneal fat in another, and herniation of extraperitoneal fat and blood in the third. One patient had both a flank hematoma and a pelvic fracture with herniation of bowel. Acute traumatic lumbar hernia is a rare but significant abnormality that should be considered in patients with blunt abdominal trauma, especially in those with large flank hematomas and pelvic fractures. The hernia contents, associated injuries, and disrupted muscle layers are all well demonstrated on CT.
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PMID:Traumatic lumbar hernia: CT diagnosis. 210 71

We described a case of late-infantile form of galactosialidosis. This male patient was a product of normal pregnancy. His parents were first cousins. He first sat at eight months, walked and talked at two years of age. His gait gradually became unsteady and he was diagnosed as spastic paraparesis at the age of five years. Abnormally slow learning was first pointed out at seven years of age. At the age of nine years, we evaluated him in detail at our university hospital. Physical examination revealed a short stature for his age, slightly coarse face, short neck, funnel chest, genu, pes and hallucis valgus. Corneal clouding, hernia and angiokeratoma were not found. Neurological examination showed mental retardation, bilateral optic atrophy without cherry-red spots, and spastic and slightly ataxic gait. Slight muscular atrophy with weakness was also seen in the extremities, more remarkable in the lower limbs. Deep tendon reflexes were hyperactive with bilateral ankle clonus and no extensor planter response. Routine examination of blood, urine and cerebrospinal fluid were normal except for approximately 10% lymphocytes containing cytoplasmic vacuoles. X-ray films of the backbone exhibited vertebral plana with anterior breaking at the second lumbar vertebra level. The electroencephalography showed the multiple spike and slow wave complexes. Brain CT depicted the atrophy of cerebellum. The activities of sialidase and beta-galactosidase were markedly reduced in white blood cells and cultured skin fibroblasts in this patient. His urinary excretion of sialyloligosaccharides increased.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Late-infantile form galactosialidosis with psychomotor retardation and spastic paraparesis]. 251 61


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