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

Respiratory failure from pulmonary hypoplasia continues to be the major cause of death in newborn infants with diaphragmatic hernia. Recent investigations have suggested that postnatally induced pulmonary injury can result from excessive positive or negative intrathoracic pressure and contribute to the respiratory deterioration. Therefore, the method of thoracic drainage on the side of the diaphragmatic hernia is critical in controlling and maintaining normal intrathoracic pressure in both intrathoracic spaces. No chest tube or an ipsilateral chest tube connected to water seal, can result in either excessive negative or positive intrathoracic pressure and, therefore, both methods should be avoided. Recently, we employed a "balanced" intrathoracic drainage system which maintains the ipsilateral intrathoracic pressure within the normal physiologic range of +2 to -8 cm H2O regardless of the degree of pulmonary hypoplasia, presence of an ipsilateral pulmonary air leak, straining by the infant, or mechanical ventilation. This system is simple, requires no suction apparatus, and is easily assembled with equipment readily available within the hospital. This technique has been utilized in 18 newborn infants with diaphragmatic hernia and pulmonary hypoplasia. There have been no complications which specifically could be related to the balanced drainage system.
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PMID:"Balanced" thoracic drainage is the method of choice to control intrathoracic pressure following repair of diaphragmatic hernia. 404 68

Urethral stricture in the tropics may be a serious public health problem; the majority of cases are caused by the gonococcus. The pathology is varied, and many advanced cases with complications are seen. Most strictures are seen in the posterior urethra, where fibrosis and narrowing may extend from a short length of under 5 mm to well over 10 cm. A wide variety of complications occurs. Diagnosis is easy when the patient presents in acute retention or with a history of difficult micturition, but more difficult when stricture is the underlying cause of perianal abscess, gangrene of the scrotum caused by extravasation, uremia or hypertension, hernia or rectal prolapse, urinary infection, or elephantiasis of scrotum with multiple fistulae. A careful history is helpful, paricularly if previous gonorrhea is involved. Physical examination varies according to mode of presentation and complications; a rectal examination and neurological examination should be included. Definitive investigation to prove the presence of a stricture includes urethrography and urethroscopy, if facilities are available. Indirect methods of diagnosis include tests for hemoglobin, blood urea, plain X-ray of the whole urinary tract, urinalysis, and others. It is preferable to leave instrumentation until last in diagnostic cases, to avoid infection, but a diagnostic bougie may be passed under strict aseptic conditions prior to treatment. The mainstay of treatment is regular bouginage for life, which is best done in a bougie clinic held at regular intervals. Equipment for bouginage, in order of desirability, includes soft plastic bougies, straight metal bougies, or curved metal bougies in larger sizes, a large stainless steel instrument tray, a basin for sterile water, and lubricant. Care should be taken during bouginage not to pass bougies into acutely inflamed strictures, and not to overstretch the urethra. Plastic bougies are preferable, until a stable situation has been reached. Surgery is indicated for a persistently impassable stricutre, for 1 requiring difficult bouginage at frequent intervals with many failures, for an established false passage, and for complications, especially bladder neck stenosis. Instructions for intravenous pyelograms and for urethrography from below and above, and diagrams of urethrograms indicating various pathological states and a diagnostic schema for urethral stricture are included.
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PMID:Urethral stricture. 469 33

Combined high-frequency oscillatory ventilation (HFOV) and intermittent mandatory ventilation (IMV) was used in 12 neonates with inadequate gas exchange with conventional IMV. Diagnoses included diaphragmatic hernia with hypoplastic lungs, pneumonia, persistent fetal circulation, and severe respiratory distress syndrome. In most patients there was severe air leak. Within 10 hours of beginning HFOV-IMV the mean arterial PCO2 fell from 60 +/- 5 (means +/- SEM) to 38 +/- 2 mm Hg (P less than 0.01) and the mean IMV rate was reduced from 96 +/- 8 to 17 +/- 4 breaths per minute (P less than 0.001). The mean arterial-alveolar oxygen tension ratio rose from 0.05 +/- 0.01 to 0.09 +/- 0.01 (P less than 0.005). Mean airway pressure in the trachea was reduced from 16 +/- 2 to 10 +/- 3 cm H2O (P less than 0.05). Four patients died, three of whom had diaphragmatic hernias with hypoplastic lungs. Five of the eight survivors had mild bronchopulmonary dysplasia requiring supplemental oxygen. These studies demonstrate that in some neonates with respiratory failure who fail to respond to conventional IMV, combined HFOV-IMV can be successful.
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PMID:Combined high-frequency oscillatory ventilation and intermittent mandatory ventilation in critically ill neonates. 637 37

Oesophageal emptying was studied with scintigraphy, radiography, and the acid clearing test (ACT) in 18 patients reporting dysphagia and previously operated on with fundoplication. Radiography with contrast medium, isodense with water, revealed abnormalities in either motility or emptying capacity in 39% (7/18). A A barium meal showed abnormalities--that is, a tight repair, disruption of the fundoplication, or recurrence of the hernia--in 56% (10/18). The ACT was prolonged in 40% (6/15) of the patients. Pathological findings at scintigraphy with a solid bolus were found in 67% (12/18). Even if scintigraphy with a solid bolus is the method that identifies the highest number of patients with impaired oesophageal function among the tests used, it cannot differentiate between functional and anatomical disorders. A barium meal examination is the method of choice when an anatomical disorder is suspected.
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PMID:Scintigraphy, radiography, and acid clearing in dysphagia patients after anti-reflux surgery. 653 75

Experience with 42 cases of traumatic diaphragmatic hernia is reviewed. The correct diagnosis was most readily made when: (1) the injury was recent, (2) the tear was left sided and large with readily identifiable structures herniated, (3) appropriate diagnostic procedures were carried out (chest film, upper gastrointestinal examination, barium enema study, nuclear liver scan, computed tomography), and (4) a high index of suspicion was maintained. The diagnosis was likely to be missed when: (1) the history of trauma, usually remote, was not obtained or was disregarded, (2) the hernia was right sided with herniation of the liver or other solid (water density) organs, or (3) diagnostic tests were not properly correlated (i.e., abnormal barium enema and chest film) or were not obtained. The rather characteristic appearance of herniated liver on the nuclear liver/spleen scan is noted and its use rather than pneumoperitoneum is recommended.
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PMID:Traumatic diaphragmatic hernia: errors in diagnosis. 697 24

This is a report of myelography findings obtained in 50 patients with B 15000 (Iopamidol), a new non ionic water-soluble contrast medium. The procedure was easily carried out with a tilting table wired to a TV image amplifier. The dose of contrast medium injected intrathecally was 10 divided by 15 cm3 of a preconstituted solution containing iodine 200 or 300 mg/cm3. There were no accidents or major complications. The myelograms obtained with the test material afforded accurate diagnosis of intramedullary and extramedullary lesions, and signally of intervertebral disk protrusion and hernia.
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PMID:[Myelography with B 15000, a new nonionic water-soluble contrast medium. Technical aspects and preliminary clinical experiences (author's transl)]. 700 85

Two cases of strangulated retrocostoxiphoid hernia (Morgagni-Larrey hernias) are reported. This is a relatively rare complication, as only 66 cases have been reported, and it has a poor prognosis. The clinical picture includes three main symptomatological groups: occlusion of the colon, gastric volvulus, and small intestine occlusion. Radiological examination of the lungs by frontal and profile films is usually sufficient to establish the diagnosis rapidly, and whether surgery is indicated. In some cases, however, the symptoms are such that opacification with water soluble agents is required. Reduction of the visceral hernia and closure of the orifice is carried out after laparotomy, resection of viscera being rarely required.
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PMID:[Strangulated retrocostoxiphoid hernia. Review of the published literature and report on two cases (author's transl)]. 701 64

Previous studies have demonstrated that after intravesical inoculation of Escherichia coli, rats drinking 5% glucose-water remained bacteriuric for up to 21 days while rats drinking tap water became abacteriuric within a few days. To facilitate accurate monitoring of bacteriuria, we created a ventral bladder hernia for percutaneous aspiration of urine. After intravesical inoculation with 10(8) E. coli, rats with ventral bladder hernias demonstrated clearance of bacteria at a rate comparable to that observed in rats with intrapelvic bladders (p less than 0.01). Of rats drinking tap water, 6 of 7 (85%) with intrapelvic bladders and 8 of 9 (89%) with ventral hernias had less than 10 colony forming units per ml of urine within 9 days of inoculation. Of rats drinking 5% glucose-water, 4 of 5 (80%) with intrapelvic bladders and 6 of 8 (75%) with ventral bladder hernias had greater than 10(5) colony forming units per ml of urine 9 days after inoculation. The results suggest that this technique does not alter the antibacterial response of control or polyuric rats to E. coli inoculated intravesically.
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PMID:Ventral bladder hernia facilitates study of urinary tract infections in rats. 702 56

Ethylene glycol alkyl ethers are frequently used in industry, and accidents due to them occur. Impaired hematopoietic function and genital injury in animal experiments have been reported. Of various alkyl radicals, those with a methyl radical strongly injure them. Ethylene glycol dimethyl ether (EGDME) was administered to pregnant mice on the 7th, 8th, 9th, and 10th days of pregnancy, which is the early stage of organ formation, for examination of its effect on feti, with special reference to the presence or absence of teratogenicity. Of 97 female mice mated and sampled, 490 mg/kg of EGDME was administered to 28 as Group A, 350 mg/kg to 23 as Group B, and 250 mg/kg to 23 as Group C. Only distilled water was given to 23 mice as a control group. 1. The mother mice showed no noteworthy ecological changes after conception in any group, but showed uneventful weight gain. No weight loss or abortion due to EGDME was observed in the experimental groups. 2. As a result of the oral administration of EGDME to pregnant mice, 20% of feti died in Group A, 13.1% in Group B, and 12.6% in Group C, the fetal mortality rate increasing with increasing dosage. 3. Surface deformity was observed in 19.2% in Group A, 5.1% in Group B, and 0.3% in Group C, the rate of deformity being high in large-dose groups. External brain was most frequent, and palpebral patency, caudal defect, peritoneal hernia, and cleft palate were observed in a small number of mice each. 4. As skeletal deformity, defect of the parietal bone was observed in the mice with external brain, but no other cranial abnormality was observed. Abnormalities of cervical vertebrae appeared in 45.9% in Group A, 33.6% in Group B, and 14.6% in Group C. Costal fusion occurred in 71.2% in Group A, 54.3% in Group B, and 21.5% in Group C.
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PMID:[The teratogenic effects of ethylene glycol dimethyl ether on mouse (author's transl)]. 719 15

Dissection of embalmed and untreated water buffalo carcasses (n=10) revealed that hernias had occurred at the musculotendinous junction of the diaphragm, ventral to the foramen venae cavae and slightly lateral to the median plane. The diameter of the hernial ring varied from 7 cm to 20 cm. Herniation was more common in the right thoracic cavity with the reticulum firmly adherent to the hernia ring. Adhesions between the herniated portion of the reticulum and pleura, lung, pericardium or thoracic wall were present, while in a few cases thick fibrous tracts concealing metallic bodies were found. In two cases, involvement of esophageal groove with malalignment of cardia and reticulo-omasal opening was observed. Displacement and compression of the heart was observed in four animals.
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PMID:Patho-anatomy of herniation of the reticulum through the diaphragm in the bovine. 734 Sep 24


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