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

The experience with CAPD using the Tenckhoff catheter in 115 patients over a 7 year period has been reviewed. The general indications for CAPD in the patient with chronic renal failure are the mental and physical ability of the patient or his relatives to perform CAPD. In our series, diabetes mellitus has been a relative indication for CAPD, because diabetic patients often have vascular disease severe enough to make long-term hemodialysis difficult. The general contraindications are abdominal problems such as hernias, abdominal wall infections, inflammatory bowel disease, adhesions, and gastrointestinal stomas. Other contraindications are lumbar disk disease and respiratory insufficiency. The surgical principles of catheter insertion have been described. Complications associated with the Tenckhoff catheter were either mechanical (intraabdominal organ injury, incisional hernia, catheter leakage, catheter occlusion, or catheter dislodgement), or infectious (peritonitis or abdominal wall infection). The single most common organism isolated from effluent dialysate in 65 patients with peritonitis was Staphylococcus epidermidis in six patients (9.2 percent), and in 20 patients (30.8 percent), no organism could be isolated. For those patients who had peritonitis, the average frequency was at 8.9 months of CAPD. There were only three deaths (3 percent) directly related to the Tenckhoff catheter and these were due to peritonitis and sepsis. Only 22 (19 percent) of the 115 patients in this series had to discontinue CAPD because of its ineffectiveness or the patient's or relative's inability to perform CAPD.
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PMID:Surgical aspects of the Tenckhoff peritoneal dialysis catheter. A 7 year experience. 315 18

Home peritoneal dialysis has recently become an important addition to the therapy of chronic renal failure. Abdominal wall hernias have become more apparent as complications of this mode of dialysis, with isolated instances of incarcerations and one fatality. Results of our review of 276 patients receiving peritoneal dialysis revealed seven with hernias, an incidence of 2.5 per cent. Six patients with hernias were receiving c.a.p.d.; one patient was receiving c.c.p.d., and none was receiving i.p.d., for incidences of 17, 5 and zero per cent, respectively. All hernias found at presentation occurred within two to 20 months after peritoneal catheter placement. Most were ventral or umbilical, and all were repaired electively without serious complications. All patients with hernias had associated problems with leaks, peritonitis or predialysis hernias. In two of four patients with predialysis hernias, herniorrhaphy without catheter removal resulted in two recurrences. Abdominal wall hernias are a more frequent complication of c.a.p.d. and c.c.p.d., modalities which require large volumes of peritoneal dialysate during ambulatory hours. Review of the literature reveals that wound tensile strength and healing are decreased in those patients having renal disease with uremia, anemia and malnutrition. However, these factors do not increase the over-all incidence of hernias. Patients should be screened for hernias, and hernias should be repaired prior to catheter placement. Hernias presenting during dialysis are best treated by herniorrhaphy and hemodialysis postoperatively or low volume peritoneal dialysis to optimize the metabolic state.
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PMID:Abdominal wall hernias as a complication of peritoneal dialysis. 664 75

Over a 10-year period, 1,990 end-stage renal disease patients in 30 centers were treated with continuous ambulatory peritoneal dialysis by the Italian Cooperative Peritoneal Dialysis Study Group. At the start of treatment, patients had an average age of 58.4 years, with a 66% prevalence of one or more clinical risk factors for premature death. Patient survival was 51% and 33% at 4 and 8 years on continuous ambulatory peritoneal dialysis, respectively, and technique survival was 62% and 48%, respectively. Occurrences of peritonitis progressively reduced until they reached an incidence of 0.50 episodes/yr in the last 5 years (1985 to 1989). Hernias and catheter-related problems did not influence the dropout rates. These Italian Cooperative Peritoneal Dialysis Study Group results demonstrate that continuous ambulatory peritoneal dialysis is a viable dialysis technique for long-term treatment of chronic renal failure and that it is an effective alternative to hemodialysis, especially for older and high-risk patients.
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PMID:Long-term outcome in continuous ambulatory peritoneal dialysis: a 10-year-survey by the Italian Cooperative Peritoneal Dialysis Study Group. 797 26

Five male patients mean age 31.8 years with lower ureteric obstruction from urinary tract schistosomiasis have been treated by bilateral uretero-ileocystoplasty. All the 5 patients had bilateral hydroureters and hydronephrosts and 3 had reversible chronic renal failure whilst one patient presented with anuria and acute renal failure. Fibrosis of lower 1/4th to 1/3rd of the Ureters was present in the 5 patients. Four patients survived the operation for a mean of 3.4 years (range 1-7 years). The post-operative complications were hypernatraemic hyperchloraemic metabolic acidosis in 3 and incisional hernia in one. There was one death from septicaemia complicating infected bilateral nephrostomies performed before ureteroileocystoplasty. Ureteroileocystoplasty is recommended for replacement of damaged ureters where the extent of the damage precludes ureteroneocystostomy or where previous ureteroneocystostomy has failed.
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PMID:The use of small intestinal segments to replace diseased bilharzial ureters--a prospective study. 831 14

We successfully used argon plasma coagulation (APC) to treat two cases of dialysis patients with hemorrhagic gastric angiodysplasia. Gastric angiodysplasia is recognized as an important cause of gastrointestinal bleeding. Angiodysplastic lesion confined to the gastric antrum was first described in 1953 and named gastric antral vascular ectasia (GAVE). The condition is characterized as submucosal capillary dilatation and fibromuscular hyperplasia. The typical finding of GAVE is the so-called watermelon stomach, attributable to vasodilatation. In case 1, a 69-year-old man was introduced continuous ambulatory peritoneal dialysis (CAPD) in July 1997 because of chronic renal failure due to nephrosclerosis. He was hospitalized for severe anemia in December 1997. Gastrointestinal fiberscopy (GIF) showed oozing in the antrum, and gastritis and esophagitis with sliding hernia. Famotidine was started and recombinant human erythropoietin (rHuEPO) was used for anemia. However, the severe anemia did not improve. The patient was hospitalized again for severe anemia and hematemesis. Another GIF showed typical watermelon stomach, which corresponded with GAVE. An APC was performed without complications. Three months later, the anemia was improved, and the dose of rHuEPO was reduced. In case 2, a 57-year-old woman was introduced to hemodialysis in 1998 for uremia due to nephrosclerosis. In October 2000, she was hospitalized for rHuEPO-resistant anemia. A GIF showed oozing in the antrum with diffuse vasodilation in the antrum; GAVE was diagnosed. An APC was carried out without complications. Three months later, anemia was improved. Recently, gastric angiodysplasia was reported to be an important complication in dialysis patients and was recognized as an important cause of rHuEPO-resistant anemia. Argon plasma coagulation is an effective treatment for gastric angiodysplasia in patients on dialysis.
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PMID:Gastric angiodysplasia in patients undergoing maintenance dialysis. 1476 50

We present an interesting but high-risk case of an obese male patient aged 56 years with dextrocardia and a left diaphragmatic hernia. Anterior myocardial infarction was diagnosed in 1994, and the patient later presented with a history of unstable angina. The diagnosis for this chronic smoker was triple-vessel disease, impaired left ventricular function, chronic renal failure, chronic bronchitis, impaired lung function, pulmonary hypertension, hypertension, diabetes, and chronic active gastritis (EuroSCORE of 10). The patient underwent successful off-pump coronary artery bypass grafting with 3 saphenous vein grafts to the left anterior descending, obtuse marginal, and right posterior descending arteries. He was discharged home 8 days later.
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PMID:Off-pump coronary artery bypass grafting in a high-risk dextrocardia patient: a case report. 1526 98

Peritoneal dialysis is becoming more and more common as a method of treating patients at the final stage of renal failure. In the year 2002 the number of patients treated with this method in Poland amounted to 1324. Studies have demonstrated that inguinal and abdominal hernias develop more frequently in chronic renal failure patients. The percentage of patients with hernia diagnosed within the first five years of dialysis is about 10%. Continuation of dialysis with the hernia condition left untreated may result in severe complications which are the third most frequent cause of converting treatment method into hemodialysis in PD patients. Currently in Poland there is no national standard in existence as to the management of hernias, and the only British standard from 1998 does not reflect the present expertise of either surgical treatment or dialysis methods. The aim of the current questionnaire based study investigating Polish peritoneal dialysis centers was to assess the treatment when hernia had been diagnosed in the PD patient. Of 49 dialysis centers in Poland, 39 do have protocols on managing the patient before and after the operation. A considerable diversity has been found as to surgical techniques used and the ways the patients are managed in hospital. Following the need expressed by 33 dialysis centers in Poland for some standard for relevant procedures, the authors formulated principles of modern hernia treatment in PD patients. Accordingly, the main principles include: 1) consulting a surgeon collaborating with the center before qualifying for peritoneal dialysis and when hernia symptoms have manifested; 2) Tension-free methods used in a treatment of choice (recommended by PHS); 3) Application of antibiotic prophylaxis (preferably first generation cephalosporin); 4) Induction of local or epidural anesthesia; 5) Peritoneal dialysis programme does not need to be discontinued but low volume dwells or preferably intermittent APD is recommended immediately after surgery.
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PMID:Management of inguinal hernia on peritoneal dialysis: an audit of current Polish practice and call for a standard. 1684 Dec 85

The Wilms tumor suppressor gene, WT1, plays an important role in the development of the urogenital system and the gonads, and clinical syndromes associated with WT1 mutations, such as WAGR syndrome, Denys-Drash syndrome and Frasier syndrome, typically manifest as renal and genitourinary abnormalities. WT1 may also play an important role in the development of the diaphragm, and recently several papers have reported an association between WT1 mutations and diaphragmatic hernias. In addition, WT1 mutations were also detected in some patients with Meacham syndrome, a rare malformation syndrome comprising congenital diaphragmatic hernia, double vagina, sex reversal, and cardiac malformations. Here, we report a case of an infant with typical clinical features of Deny-Drash syndrome and a heterozygous missense mutation, Arg366His, in the WT1 gene, in whom a diaphragm defect was detected after starting peritoneal dialysis. Diaphragmatic defects are rare but may be considered as clinical manifestations of WT1 mutation syndromes. In addition, we suggest that WT1 abnormalities should be suspected in patients with chronic renal failure who develop hydrothorax after peritoneal dialysis, especially in those with genitourinary abnormalities.
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PMID:Hydrothorax in a patient with Denys-Drash syndrome associated with a diaphragmatic defect. 1693 93

Bladder involvement in inguinal hernia is relatively rare, 1-4%, although the incidence is increased to 10% with advancing age or obesity. There are several previously reported cases presenting with obstructive uropathy and renal failure, but all reversed with urinary diversion and hernia repair. We believe this to be the first reported case of bladder hernia leading to dialysis dependent chronic renal failure.
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PMID:Chronic Dialysis Dependent Renal Failure Resulting from a Massive Bladder Containing Inguinal Hernia. 2855 70