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

Twenty percent of our patients who have had colostomy use irrigation to regulate the bowels. This decision is made by the patient himself after careful deliberation. By means of an irrigation set the large intestine is irrigated with approximately 1-1.5 l of water at body temperature. Subsequently there is a stool-free period of 24-28 h and a reduction of flatulence. The duration of irrigation is 45-60 min. Side effects are occasionally pressure sensation and mild convulsive symptoms, but there are no significant complications. Irrigation can begin after complete healing of the stoma, but is absolutely contraindicated in inflammatory intestinal diseases and relatively contraindicated in prolapse, hernia, stenosis, and intestinal damage by radiation.
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PMID:[The value of irrigation]. 257 30

Dichloroacetonitrile (DCAN), a by-product of drinking water disinfection formed by reaction of chlorine with background organic materials, was evaluated for its developmental effects in pregnant Long-Evans rats. Animals were dosed by oral intubation on Gestation Days 6-18 (plug = 0) with 0, 5, 15, 25, or 45 mg/kg/day. Tricaprylin was used as a vehicle. The highest dose tested (45 mg/kg) was lethal in 9% of the dams and caused resorption of the entire litter in 60% of the survivors. Embryolethality averaged 6% per litter at the low dose and 80% at the high dose and was statistically significant at 25 and 45 mg/kg/day. The incidence of soft tissue malformations was dose related and was statistically significant at doses toxic to the dam (45 mg/kg). These anomalies were principally in the cardiovascular (interventricular septal defect, levocardia, and abnormalities of the major vessels) and urogenital (hydronephrosis, rudimentary bladder and kidney, fused ureters, pelvic hernia, cryptorchidism) systems. The frequency of skeletal malformations (fused and cervical ribs) was also dose related and significantly increased at 45 mg/kg. The no-observed-adverse-effect dose for toxicity in pregnant Long-Evans rats was established by statistical analysis to be 15 mg/kg/day.
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PMID:Developmental toxicity of dichloroacetonitrile: a by-product of drinking water disinfection. 274 78

Female CD-1 mice were exposed to Tordon 202c (a picloram and 2,4-D combination herbicide) in the drinking water at concentrations of 0.21, 0.42, and 0.84% for 60 days prior to mating with untreated males. One-half of the pregnant females subsequently continued treatment throughout gestation while the remaining females were maintained on distilled water. Fetal weight, crown-rump length, placental weight, and maternal gestational weight gain were reduced in a dose-dependent manner following combined preconceptional and gestational exposure. The incidence of malformed fetuses (cleft palate, renal agenesis, hydronephrosis, unilateral testicular agenesis, and umbilical hernia) and fetuses with variants (especially incomplete ossification of the skeleton) were increased in a dose-dependent manner following combined exposure. Increased maternal mortality and decreased preconception weight gain were observed in the highest-dosage group. Relative maternal liver weight was increased in a dose-dependent manner. The results suggest that combined preconceptional and gestational exposure to Tordon 202c is required for teratogenesis and fetal growth depression. Preconceptional exposure alone is not effective in increasing the risk for embryotoxicity.
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PMID:Effects of preconceptional and gestational exposure to Tordon 202c on fetal growth and development in CD-1 mice. 278 33

Safe management of the newborn infant with congenital diaphragmatic hernia (CDH) requires precise fluid administration to avoid hypovolemia or fluid overload. Twenty-two CDH patients and 12 infants who underwent abdominal operations were studied for three postoperative days to determine whether the postoperative neonatal renal response to fluid administration was appropriate or inappropriate. Each response was categorized, on the basis of urine and blood measurements, as: (1) appropriate urine output and concentration, (2) inappropriate urine output and concentration with fluid retention or (3) renal failure. Fluid intake was similar in all groups. The CDH group had a significantly lower urine output, higher urine osmolarity, and lower serum osmolarity. All of the control group (100%) responded appropriately to intake. Sixty-four percent of the CDH group inappropriately retained water during the first 16 hours (appropriate, 27%; renal failure, 9%). By 24 hours, 34% still had inappropriate urine output and fluid retention. The majority of patients with CDH initially responded inappropriately to postoperative fluid intake. If this response is not recognized and fluid intake is not adjusted, serious fluid overload will result.
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PMID:Inappropriate fluid response in congenital diaphragmatic hernia: first report of a frequent occurrence. 285 19

Syringomyelia management is showing some progressive improvements following surgical methods of investigation and treatment. Investigation of simultaneous pressure changes in the cerebrospinal fluid pathways has illustrated the importance of craniospinal pressure dissociation in impacting the cerebellar and medullary tissues in the foramen magnum in hindbrain related syringomyelia. Such pressure differences may be referred to as 'suck' and similar changes are to be found in non-hindbrain related forms of syringomyelia such as those associated with spinal arachnoiditis. When cavities have formed then impulsive movements may occur with them and enlargement of the cavities may be continued by sloshing of the fluid within them. Investigations have been improved following the widespread use of water soluble contrast media and CT scanning with reconstructions after myelography. A definite relationship between birth injury and hindbrain related syringomyelia has been established especially with cases showing arachnoiditis. The nature of the relationship to hindbrain hernia and basilar invagination remains unclear. Magnetic resonance imaging holds great promise particularly in showing hindbrain deformation in new-born babies, showing whether or not a communication commonly exists between the fourth ventricle and the cavities within the spinal cord in early childhood and also in outlining the changes in the spinal cord in the presence of acute traumatic paraplegia. Treatment still relies upon valved ventricular to extrathecal shunts for hydrocephalus, cranio-vertebral decompression to prevent suck and drainage of the syrinx in appropriate cases. Syrinx to extrathecal shunting may be preferred to shunts to the subarachnoid space. The peritoneum and the pleura are favoured sites and a valve is not necessary. The advances for the future may depend on earlier diagnosis and greater understanding of the mechanisms of pathogenesis in which MRI seems likely to play an increasingly important part.
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PMID:Progress in syringomyelia. 287 6

A case of herniation of the cecum through the foramen of Winslow is reported in a 49-year-old man, admitted for acute abdominal pain. Diagnosis, suspected by abdominal plain films, and established by water-soluble enema, was confirmed by emergency surgical management. Herniation through Winslow's foramen represents the least common variety of internal hernias. Only 136 observations were previously reported, the cecum being involved in 25-30% of cases. Radiological diagnosis was made in only one patient out of ten. Although rare in occurrence, it carries a high mortality risk when diagnosis and treatment are delayed. A better appreciation of the classic radiological features will allow for earlier recognition and treatment. Therefore, the authors emphasize the interest of radiologic findings in this condition.
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PMID:[Cecal hernia through Winslow's foramen. Radiographic study of a case and review of the literature]. 304 78

Bendectin, composed of doxylamine succinate and pyridoxine HCl (1:1), is an antinauseant previously prescribed for nausea and vomiting during pregnancy. The present study examined the maternal and developmental effects of Bendectin (0, 200, 500, or 800 mg/kg/day, po) administered to timed-pregnant CD rats (36-41/group) during organogenesis (gestational days [gd] 6-15). At death (gd 20), all live fetuses were examined for external, visceral, and skeletal abnormalities. At 500 and 800 mg/kg/day, maternal toxicity included reduced food consumption during treatment and for the gestation period, increased water consumption in the posttreatment period, reduced weight gain during treatment, and sedation; water consumption was reduced during treatment and for the gestation period, and maternal mortality (17.1%) was observed only at the high dose. Developmental toxicity included reduced prenatal viability (800 mg/kg/day) and reduced fetal body weight/litter (500 and 800 mg/kg/day). In addition, reduced ossification of metacarpals (800 mg/kg/day), phalanges of the forelimbs (500 and 800 mg/kg/day), and of caudal vertebral centra (all doses) was observed. No increase in percent malformed live fetuses/litter was observed. The proportion of litters with one or more malformed fetuses was higher than vehicle controls only at 800 mg/kg/day, with short 13th rib (to which the test species is predisposed) as the predominant observation. By contrast, a positive control agent (nitrofen, 50 mg/kg/day, po, 14 dams) produced 85% malformed fetuses/litter with the predominant malformation being diaphragmatic hernia. In conclusion, the incidence of litters with one or more malformed fetuses was increased only at a dose of Bendectin which produced maternal mortality (17.1%) and other indices of maternal and developmental toxicity (see Discussion).
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PMID:Developmental toxicity evaluation of Bendectin in CD rats. 340 69

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

Thirty-two infants were treated for congenital diaphragmatic hernia at our institution from 1979 to 1984. Eight were in no or minimal distress at birth and had operative intervention when they were more than 24 hours old; survival was 100%. The remaining 24 neonates required immediate intubation and ventilation followed by operation at less than 12 hours of age. Overall survival was 54%; survival was 31% (4 of 13 patients, Group 1) in the first three years of the series and 82% (9 of 11 patients, Group 2) in the last three years (p less than 0.001). Apgar score, gestational age, birth weight, and incidence of associated congenital heart disease were equal for the two groups (all, p greater than 0.05). The two groups also were examined with reference to alveolar-arterial oxygen differences P(A-a)O2 and mean airway pressure (MAP). The best preoperative P(A-a)O2 was greater than 600 mm Hg for 7 neonates in Group 1 and 6 in Group 2, and survival was 0% and 71%, respectively (p less than 0.001). Infants with a postoperative MAP of 13 cm H2O or greater had a higher mortality (100% in Group 1 and 50% in Group 2, p greater than 0.05). Our treatment protocol was studied to determine those methods related to improved survival. Sodium bicarbonate infusion was used earlier in Group 2 as a prophylaxis against persistent fetal circulation (PFC) (p greater than 0.05). The incidence of severe PFC dropped from 85 to 54% (p greater than 0.05). Higher ventilator rates rather than pressures were used to achieve equally effective ventilation.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Improving survival in the treatment of congenital diaphragmatic hernia. 394 36

The diaphragm is the most important muscle of respiration. It is believed that the abdominal contents affect diaphragmatic contraction by helping determine its length tension state and by acting as a fulcrum for this muscle to lift the rib cage and thereby increase lung volume. In support of these concepts we describe a patient with severe chronic obstructive pulmonary disease and a large midline hernia of the abdomen who, when standing, had a gastric pressure (Pg) of 4 cm H2O and a maximal transdiaphragmatic pressure (Pdimax) of 14 cm H2O. This was associated with an O2 saturation of 82%, lower thoracic and upper abdominal paradoxical breathing, and severe dyspnea. Once the hernia was reduced there was a rise in Pg to 12 cm H2O, of Pdimax to 27 cm H2O, and of O2 saturation to 89%. There was normalization of the breathing pattern and a decrease in dyspnea. Reduction of this patient's abdominal hernia resulted in an increase in her exercise tolerance.
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PMID:Respiratory consequences of abdominal hernia in a patient with severe chronic obstructive pulmonary disease. 396 6


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