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At least 163 records · Page 9Linked to original sources
PubMed1994

Randomized trial of modified Bassini versus Shouldice inguinal hernia repair. The Cologne Hernia Study Group.

Between 1986 and 1992, 265 men of mean age 51 (range 16-75) years with a primary inguinal hernia were randomized to undergo surgery by staff surgeon or surgical resident and further randomized to receive a modified Bassini operation (transversalis fascia not divided but included in the repair) or Shouldice procedure. The follow-up rate was 92.1 per cent with a mean follow-up of 3.3 years. Recurrence developed in 12 of 125 patients with a Bassini procedure and two of 119 after a Shouldice repair (9.6 versus 1.7 per cent, P = 0.006). The recurrence rate was no different for staff surgeons and trainees (5.9 versus 5.6 per cent, P not significant). Multivariate analysis identified the presence of a direct hernia (P = 0.003) as the additional main factor for the development of recurrence.

Adolescent↗
PubMed1999

Handlebar hernia with intra-abdominal extraluminal air presenting as a novel form of traumatic abdominal wall hernia: report of a case.

An 18-year-old male was admitted to our Emergency Department with a traumatic abdominal wall hernia (TAWH) of the left lower quadrant (LLQ) after suffering hypogastric blunt injury and urogenital lacerations in a motorcycle accident. Upright chest X-ray showed a small amount of right infradiaphragmatic free air, and a computed tomographic (CT) scan demonstrated an abdominal wall hernia. At surgery, no impairment was found in the digestive tract, and an abdominal herniorrhaphy was performed. It is suggested that the free air had passed through a connection between the scrotal laceration and the contralateral abdominal defect via the subcutaneous space and was palpated as emphysema. This is a new type of TAWH, which suggests that blunt abdominal trauma may result in negative pressure in the subcutaneous and peritoneal cavity, and this could reflect the pathophysiology of TAWH.

Abdominal Muscles↗
PubMed2001

The value of CT diagnosis of hernia recurrence after prosthetic repair of ventral incisional hernias.

Herein we present a prospective study made to compare the diagnostic value of a physical examination and a CT scan in the detection of a hernia relapse after carrying out of a intraperitoneal hernioplasty using a non-resorbable mesh. Fifty patients operated on for intraperitoneal hernioplasty with ePTFE mesh and postoperative symptomatology were assessed within a year of the operation via a physical exploration and CT. Each of the patients was subjected to an exploratory laparoscopy for the purpose of confirming the diagnosis. The data were analysed statistically using a chi-square test, sensitivity, specificity, confidence limits, positive predictive value, and negative predictive value. The hernia relapse was correctly diagnosed in 98% of cases by CT and in 88% of cases in the physical examination. The sensitivity was 1 in the CT examination and 0.75 in the physical examination, and the specificity results were 0.97 and 0.90, respectively. The positive predictive value in the CT exam was 0.88, whereas in the physical examination it was 0.60. The negative predictive values were 1 and 0.95, respectively. The differences between the values of both methods held a statistical meaning (chi-square test; p < 0.05). The postoperative assessment by CT of symptomatic patients who have been operated on for an intraperitoneal hernioplasty with unabsorbable mesh facilitates carrying out a correct diagnosis in the detection or exclusion of hernial relapse.

Adult↗
PubMed2006

A case of symptomatic Morgagni's hernia and a review of Morgagni's hernia in Japan (263 reported cases).

An 81-year-old female patient was admitted to the emergency room of our hospital with complaints of respiratory distress, abdominal ache, nausea, and intermittent vomiting. A plain X-ray of the abdomen and chest revealed air-fluid levels on the abdomen and the right side of the chest. Laboratory tests showed severe acidemia with a blood base excess level of -24.9 mmol/L. Since the patient was considered to have acute intestinal obstruction due to transverse colon herniation into the thorax through a foramen of Morgagni, emergency surgery was performed. Operative findings revealed that the retrosternal diaphragm had a defect of 5 cm in diameter and 20 cm in length with the transverse colon herniated into the thorax. The diaphragm defect was sutured first, and partial resection of the transverse colon was performed. After the operation, the patient had no symptoms and no recurrence has been observed during the 1-year follow-up. There have been 263 reported cases of Morgagani hernia in Japan. The case of the Morgagni hernia is reported here with some bibliographical comments.

Aged, 80 and over↗
PubMed2003

[The Prolene Hernia System for inguinal hernia repair].

Prosthetic repair is now considered as a standard in hernia surgery. The authors describe herein the technique of placement of Prolene Hernia System (PHS) which has the feature of a "3 in 1 system" according to the principles of Rives and Stoppa on one hand and those of Lichtenstein on the other hand. The steps of surgical technique are described.

Digestive System Surgical Procedures↗
PubMed1993

Anterolateral diaphragmatic hernia: is it a Morgagni hernia?

Three unusual cases of large anterolateral congenital diaphragmatic hernia are described with emphasis on its embryogenesis. This type of diaphragmatic defect is rare and underemphasized. Its clinical spectrum ranges from the asymptomatic case to those with acute respiratory distress. It may present itself as a solitary defect or as part of a more complex association such as the thoracoabdominal syndrome. This defect should be differentiated from Morgagni (and other anterior) diaphragmatic hernias by its size and lateral extension and the presence of left pulmonary hypoplasia. Treatment is by primary operative repair, and prognosis depends on the presence and severity of associated malformations.

Abnormalities, Multiple↗
PubMed1996

Two cases of paraduodenal hernia, a rare internal hernia.

Paraduodenal hernia is a rare congenital internal hernia which arises from an error of rotation of the midgut with entrapment of the small intestine beneath the developing colon. It is important as it usually presents as intestinal obstruction, and before laparotomy is often misdiagnosed. Mortality increases significantly with delays in surgical treatment. Two cases are presented: an 8 year old boy and a 52 year old man. Both presented with a short history of abdominal pain and an acute abdomen. With prompt surgical treatment, they recovered rapidly.

Abdominal Pain↗
PubMed2001

Amyand's hernia: a case report of an incarcerated and perforated appendix within an inguinal hernia and review of the literature.

Appendicitis within an Amyand's hernia is rare; when it occurs it is often misdiagnosed as a strangulated inguinal hernia. We present a case report of such a case and a review of the literature. It is our recommendation that repair should be undertaken without the use of synthetic mesh through a properitoneal incision that gives access to the peritoneal cavity and the inguinal regions.

Aged↗
PubMed1987

[10 years' experience using a modified Shouldice surgical technic for inguinal hernia in adults. II. Which factors modify the recurrence of inguinal hernia?].

Many factors seem to influence the recurrence rate after adult inguinal hernia repair. A statistical analysis of data derived from 726 transversalis fascia repairs examined by the authors (with a follow-up rate of 82.5% and a mean follow-up time of 5.5 years) revealed a significantly higher recurrence rate in patients with chronic bronchitis (p less than 0.05) or with postoperative complications (p less than 0.001). Lower recurrence rates were found after resection of lipomas of the cord (p less than 0.01) or cremasteric muscle resection (p less than 0.05). No significant difference of recurrence rate could be established for following parameters: Sex, side, age distribution, profession, prostatism, obesity, type of hernia (direct, indirect, combined, sliding), suture material (silk, polyglycolic acid), surgeon, anesthesia (local, spinal, full), elective or emergency operation, and whether the repair was unilateral or simultaneously bilateral. Recurrent repairs showed no significantly higher recurrence rate than primary repairs.

Adult↗
PubMed1983

[Role of genetic factors in the occurrence of umbilical hernias in cattle. II. Heredity and the incidence of umbilical hernia in various crossing variants].

To determine ethyology of Hernia umbilicalis in black-spotted cattle stock, a check crossing was carried out. The incidence of anomalia in the bull progeny of Zakaznik 82 (black-spotted breed) was 44%, this value being 107 in the progeny of Block 107 (holsteinfrisish breed) and 0% in the progeny of Vyaz 338 (holmogorsky breed). The data obtained indicate that Hernia umbilicalis is a hereditary anomaly in cattle.

Animals↗
PubMed1990

Pathophysiology of congenital diaphragmatic hernia: I. Renal enlargement suggests feedback modulation by pulmonary derived renotropins--a unifying hypothesis to explain pulmonary hypoplasia, polyhydramnios, and renal enlargement in the fetus/newborn with congenital diaphragmatic hernia.

Survival of newborns with congenital diaphragmatic hernia (CDH) is largely dependent on the severity of pulmonary hypoplasia (PH) present at birth. Intrathoracic compression by the herniated abdominal viscera is thought to be the primary factor involved in the pathogenesis of the PH in CDH. Humoral and/or amniotic pulmonary growth factors (PGF) have been hypothesized to play a role in normal fetal pulmonary development and may be involved in the pathogenesis of CDH as well. The hypothesis of this paper is that growth of the fetal lung is stimulated by a PGF produced by the kidneys, which is modulated by a feedback signal from the lungs, a pulmonary derived renotropin (PDR). In the fetus with CDH, the lungs may be unable to respond to PGF due to compression by the herniated abdominal viscera. Theoretically, PH associated with CDH would maximally stimulate this feedback loop to release more PDR, resulting in continual stimulation of the kidneys and renal enlargement. If such a scheme plays a role in the in utero pathophysiology of CDH, then newborns with CDH should have enlarged kidneys. To investigate this hypothesis, we reviewed 30 autopsy cases of newborns with CDH and analyzed their kidney weights versus body weights, using historical data as control. Kidney weights in CDH cases were greater than the control population in 77% of the cases; 57% of kidney weights were more than one standard deviation above control values. Adjusted group mean kidney weights were 29.8 g (+/- 1.0 SE) in CDH cases and 25.9 g (+/- 1.5 SE) in the control population (P less than .04). These data support our hypothesis and demonstrate that in newborns with CDH and morphologically normal kidneys, there is significant renal enlargement associated with CDH. The presumed mechanism of this renal enlargement, as well as its relationship to normal and aberrant pulmonary growth and regulation are discussed. If such a selective PGF exists, its therapeutic implications for fetuses and newborns with PH are considerable.

Analysis of Variance↗
PubMed1995

Pathophysiology of congenital diaphragmatic hernia. XVI: Elevated pulmonary collagen in the lamb model of congenital diaphragmatic hernia.

The pathophysiologic features of congenital diaphragmatic hernia (CDH) include pulmonary hypoplasia, pulmonary hypertension, surfactant deficiency, and decreased pulmonary compliance. When the surfactant deficiency is corrected using exogenous surfactant therapy, the pulmonary compliance improves, but does not reach normal values. Quasistatic saline pressure-volume measurements, which eliminate the air-liquid interface, confirm that CDH lungs are intrinsically less compliant than control lungs. The authors hypothesized that this abnormal lung compliance results from elevated concentrations of collagen and/or elastin in the lung. Therefore, they measured the collagen and elastin concentrations in CDH and control lung tissue. Also measured was the collagen concentration in the kidney, intestine, and dissected third-generation arterioles, venules, and bronchioles, to characterize further the pathology of CDH. The CDH model was created on the left side of fetuses in pregnant ewes at 80 days' gestation. The fetuses were delivered and killed at 140 days (full term, 145). The concentrations of collagen (as hydroxyproline), elastin, DNA, and total protein were measured using standard techniques. Although there was significantly more collagen per gram of lung tissue in the CDH lungs (1.334 mg/g v 0.885 mg/g in the controls) the elastin concentrations were not different. The elevated collagen concentration was not associated specifically with the conducting airways or vasculature. The collagen concentrations in CDH kidneys and intestines were the same as those of controls. The DNA/total protein ratios in the CDH and control lungs were identical. The results suggest that the elevated collagen concentration was present only in the lungs of CDH lambs, and that it was not attributable to atrophy or hypertrophy of the lungs. Thus, increased collagen in the lung parenchyma may be responsible for the intrinsic stiffness and decreased compliance of the CDH lungs.

Animals↗
PubMed1995

Pathophysiology of congenital diaphragmatic hernia. XII: Amniotic fluid lecithin/sphingomyelin ratio and phosphatidylglycerol concentrations do not predict surfactant status in congenital diaphragmatic hernia.

Abnormal development of the lung in congenital diaphragmatic hernia (CDH) results in a dysfunctional surfactant system. In premature newborns at risk for respiratory distress syndrome, amniotic fluid lecithin/sphingomyelin (L/S) ratios and phosphatidylglycerol (PG) status have been successfully used to predict the surfactant status in the fetus. The objective of this study was to assess the accuracy of L/S ratios and PG in predicting the surfactant status in CDH. The surgically created lamb CDH model was used. Animals were delivered at 140 days' gestation (term 145) and immediately killed. Before delivery amniotic fluid was collected and L/S ratios and PG status were measured. Bronchoalveolar lavage (BAL) was performed and analyzed for total phospholipid and percent phosphatidylcholine (PC). Analysis of the BAL showed that the CDH lungs had both significantly less total phospholipid (CDH 0.10 +/- 0.03 mg/g versus control (CON) 0.76 +/- 0.28 mg/g) and PC (CDH 38 +/- 7.3% versus CON 70 +/- 3.4%) when compared with controls. In contrast the L/S ratios (CDH 2.44 +/- 0.26 versus CON 2.01 +/- 0.32) and PG status (CDH 8.75 +/- 1.01 nmol versus CON 10.2 +/- 0.9) were the same in CDH and control animals. The BAL from the CDH lamb model has a significant surfactant deficiency. Amniotic fluid L/S ratios and PG status were, however, not different between the control and CDH lambs. These results indicate that amniotic fluid L/S ratios and PG do not accurately predict the surfactant status of a fetus with CDH.

Amniotic Fluid↗
PubMed1995

Pathophysiology of congenital diaphragmatic hernia. X: Localization of nitric oxide synthase in the intima of pulmonary artery trunks of lambs with surgically created congenital diaphragmatic hernia.

The pathophysiology of congenital diaphragmatic hernia (CDH) results from a combination of pulmonary hypoplasia, pulmonary hypertension, and surfactant deficiency. Previously we demonstrated that inhaled nitric oxide (NO), a known vasodilator, only improves oxygenation and decreases pulmonary artery pressures when the lamb model of CDH is pretreated with exogenous surfactant. Nitric oxide synthase (NOS) in endothelial cells is responsible for the production of NO, a mediator of smooth muscle cell relaxation. Pulmonary hypertension in CDH may result from a defect in the endogenous production of NO. Our aim was to determine whether the main pulmonary artery trunks in CDH lambs have NOS immunoreactivity. Cryostat sections of paraformaldehyde-fixed specimens of pulmonary artery and aortic rings from 10 CDH lambs and five control lambs were processed for NADPH-diaphorase activity. Immunolocalization of NOS was studied in paraformaldehyde-fixed sections and compared with serially cut specimens from identical rings that were tested for NADPH-diaphorase activity. Intense NADPH-diaphorase staining was present in the intimal layer (endothelial lining) of the pulmonary artery and aortic rings of both the CDH and control lambs. This activity colocalized with NOS immunoreactivity in all specimens. Both NOS immunoreactivity and NADPH-diaphorase staining were lacking in cartilage, which were used as negative controls. NOS is present in the main pulmonary artery trunks of CDH lambs. To our knowledge, this is the first report of NOS immunoreactivity in CDH. We can only speculate whether this activity is preserved in other areas of the vascular tree in CDH, ie, pulmonary capillaries and veins. Perhaps the pulmonary hypertension in CDH is not caused by an NOS deficiency.

Amino Acid Oxidoreductases↗
PubMed1999

Does extracorporeal membrane oxygenation improve survival in neonates with congenital diaphragmatic hernia? The Congenital Diaphragmatic Hernia Study Group.

BACKGROUND/PURPOSE: The benefit of extracorporeal membrane oxygenation (ECMO) in improving survival of neonates with congenital diaphragmatic hernia (CDH) has never been clearly demonstrated. This may be due to comparisons made between treatment groups of unequal illness severity and the low statistical power of analyses from previous studies. The authors analyzed the data from the multicenter CDH registry to determine if ECMO improves survival in CDH neonates with a high risk of mortality. METHODS: A total of 730 neonates were enrolled in the CDH Registry from January 1995 to November 1997. Of these, 632 neonates had a complete data set and were eligible for ECMO by the weight criterion of greater than 2.0 kg. Multivariate logistic regression analysis was used to assess mortality risk for each neonate based on previously validated independent predictors of survival: birth weight and 5-minute Apgar. Five quintile groups were defined based on increasing predictive mortality risk. Multivariate logistic regression and chi2 analyses with birth weight, Apgar score at 5 minutes, and predictive mortality risk as covariates were then performed to assess survival benefit of ECMO compared with conventional therapy alone. Patient survival rate was defined as survival to discharge from hospital. RESULTS: When analyzing all 632 neonates, ECMO neonates (n = 289) had a decidedly lower survival rate (52.9% v 77.3%, P< .001) than non-ECMO neonates (n = 343) without standardizing for the degree of illness. However, when taking into account the patients' predictive mortality risk, ECMO was associated with improved survival in the neonates with mortality risk < or = 80% (P < .05). Furthermore, ECMO was shown to be a positive independent predictor of survival when accounting for the covariates of birth weight, 5-minute Apgar, and mortality risk (P < .05). CONCLUSIONS: ECMO significantly improves survival rates for those CDH neonates with a predictive mortality risk > or = 80%. Generally, the more critically ill the patient with CDH, the more marked the survival benefit obtained.

Extracorporeal Membrane Oxygenation↗