Iatrogenic cardiac herniation and torsion after surgery for a penetrating cardiac injury. (65/217)

Cardiac herniation and torsion is a rare condition associated with a high mortality rate. We present an unusual case of sudden cardiogenic shock that was caused by torsion and herniation of the heart after an operation for a penetrating cardiac injury. The patient was successfully treated by urgent surgical intervention.  (+info)

Three-dimensional sonography of muscle hernias. (66/217)

OBJECTIVE: Muscle hernias through a defect in the fascia can be subtle and difficult to see on 2-dimensional (2D) scans. We describe the appearance of muscle hernias on 3-dimensional (3D) sonographic multiplanar scans and 3D rendering. METHODS: Two patients were examined with a 2D linear 5- to 12-MHz probe. The questionable area was scanned with a 5- to 12-MHz linear 3D transducer. Multiplanar reconstruction and 3D rendering were performed to show the hernia. RESULTS: In both cases, the muscle hernia was small and subtle on 2D scans but became slightly more prominent on examination after the muscle was exercised. In both patients, the hernias were very obvious on 3D scans. CONCLUSIONS: Symptomatic muscle hernias may sometimes be very small and difficult to see on 2D scans. Three-dimensional rendering shows the hernia very well.  (+info)

Intraperitoneal pressure in PD patients: relationship to intraperitoneal volume, body size and PD-related complications. (67/217)

BACKGROUND: The clinical determinants of intraperitoneal pressure (IPP) are ill defined, and the potential impact of elevated IPP on peritoneal dialysis (PD)-related complications is still a matter of debate. We measured IPP in newly started PD patients, assessed its clinical determinants and analysed the incidence of PD-related complications. METHOD: IPP was measured in 61 consecutive patients [46 males and 15 females, 47 automated peritoneal dialysis (APD) and 14 continuous ambulatory peritoneal dialysis (CAPD), aged: 52+/-17 years], an average of 2 months after PD onset, using increasing (from 0 to 3000 ml) dialysate volumes. The prescription of day and night dialysate infusion volumes was made to avoid IPP>16 cm H2O. We assessed the relationship between baseline clinical characteristics and IPP and the putative influence of IPP on subsequent PD-related complications, such as hernias, late leakage, gastro-oesophageal reflux (GOR) and enteric peritonitis (EP). IPP at the time of the complication was computed by linear interpolation across available couples of data (volume and IPP). Correlations were assessed using Pearson's r; Kaplan-Meier survival curves with log-rank test were used for complication occurrence analysis. RESULTS: At baseline, mean IPP was 13.5+/-3.3 (5-22.5) cm H2O for 2000 ml inflow; IPP rose linearly as intraperitoneal volume (IPV) increased [R2=0.96, 95% CI (0.88; 1.00)]. IPP was significantly higher in patients with a higher body mass index (BMI) (P=0.03) but age, gender, weight, height, body surface area (BSA), diabetes mellitus or a past history of abdominal surgery did not correlate with IPP. Incidence of abdominal wall complications or GOR was not correlated with IPP. Patients with a night IPP>14 cm H2O had a higher incidence of EP (P=0.039) and a worse survival free of EP (P=0.03). CONCLUSION: This study shows a strong linear correlation between IPP and IPV, a significant impact of BMI on IPP and a higher incidence of EP in patients with higher IPP. We recommend to measure IPP in PD patients to guide the prescription of intraperitoneal volumes.  (+info)

Herniation of the anterior lens capsule. (68/217)

Herniation of the anterior lens capsule is a rare abnormality in which the capsule bulges forward in the pupillary area. This herniation can be mistaken for an anterior lenticonus where both the capsule and the cortex bulge forward. The exact pathology behind this finding is still unclear. We report the clinical, ultrasound biomicroscopy (UBM) and histopathological findings of a case of herniation of the anterior lens capsule. UBM helped to differentiate this entity from anterior lenticonus. Light microscopy revealed capsular splitting suggestive of capsular delamination and collection of fluid (aqueous) in the area of herniation giving it a characteristic appearance.  (+info)

Surgical treatment for different forms of hernias in sheep and goats. (69/217)

Sheep and goats are frequently presented with different forms of hernias to veterinary clinics. The aim of this study is to investigate the outcome of the surgical treatment of abdominal, umbilical, inguinal and scrotal hernias in sheep and goats. Fifty-eight clinical cases (sheep = 44, goat = 14) were presented to the Veterinary Teaching Hospital, College of Agriculture and Veterinary Medicine, Qassim University, Saudi Arabia from September, 2003 to September, 2006. These animals had abdominal (sheep = 30, goat = 10), umbilical (sheep = 6, goat = 4), inguinal (sheep = 7) and scrotal (sheep = 1) hernias. All the cases of hernias in sheep and goats were subjected to full study including the history of the case, classification of hernias, the size of the hernial ring, surgical repair of the hernias, adhesions between the hernial sacs in each case, the postoperative care and follow up of the cases. The results revealed that gender had an effect on the incidence of hernia. The incidence of abdominal hernias was higher in females and the incidence of inguinal hernia was higher in males. There was a positive correlation between the history of hernia and the degree of adhesion. For the sheep, 26 out of 30 cases of abdominal hernia had good outcomes and the healing was excellent. There were postoperative complications in 4 ewes. For the goats, there were slight swellings at the site of operation in 2 out of 10 cases of abdominal hernia, while the remaining 8 cases had good outcomes. There was one case of umbilical hernia with an umbilical abscess that had broken down with sepsis formation at the surgical site. In conclusion, the success rates of surgical treatment for all types of hernias were very high and there were no significant differences in the success rates among the different types of hernias in both sheep and goats. The types of suture materials and the types of hernias had no significant effect on the outcome of the surgical treatment.  (+info)

Hip pain - a focus on the sporting population. (70/217)

BACKGROUND: Patients complaining of 'hip' or 'groin' pain can present a diagnostic and therapeutic challenge for practitioners not only in primary care, but also those in specialist practice. OBJECTIVE: This article outlines common patterns of groin and lateral hip pain, and provides a targeted clinical approach to treatment or referral. DISCUSSION: Common causes of chronic groin pain include osteitis pubis, incipient hernia, adductor tendinopathy and intrinsic hip pathology. Tendinopathy of the hip abductor muscles is a common cause of lateral hip pain. While a careful history and targeted examination is essential, the frequently nonspecific findings add to the challenge of managing this group of patients. Treatment remains focused on relative rest, although other, more active modalities are discussed. Advances in hip arthroscopy have lead to further improvement in our understanding, diagnosis and treatment of intrinsic hip pathology.  (+info)

Regression of syringomyelia and tonsillar herniation after posterior fossa arachnoid cyst excision. Case report and literature review. (71/217)

BACKGROUND: Some reports have documented posterior fossa cysts resulting in syringomyelic obstruction of cerebrospinal fluid (CSF) flow caused by cyst displacement within the foramen magnum. Rarely the syringomyelia is caused by acquired Chiari malformation due to a retrocerebellar arachnoid cyst. OBJECTIVE: To report the case of a 38-year-old man with hydrocephalus and syringomyelia, who was found to have a Chiari malformation secondary to a posterior fossa arachnoid cyst. After endoscopic third ventriculostomy, the patient was submitted to foramen magnum decompression and arachnoid cyst removal that were followed by resolution of both the Chiari malformation and the syringomyelia. DISCUSSION: In most published cases the syringomyelia has been attributed to obstruction of CSF flow at the foramen magnum by the arachnoid cyst itself. There is only one previous report of a posterior fossa arachnoid cyst producing tonsillar descent and syringomyelia. CONCLUSIONS: Posterior fossa arachnoid cysts can result in acquired Chiari malformation and syringomyelia. In our view, the management of these patients should be directed at decompressing the foramen magnum and include the removal of the walls of the coexistent arachnoid cyst as it seems to be the crucial factor that accounts for the development of the syringomyelia that these patients present.  (+info)

Broad ligament hernia-associated bowel obstruction. (72/217)

BACKGROUND AND OBJECTIVE: We present the case of a female patient 29 years of age with antecedents of laparoscopic laser ablation for endometriosis, laparoscopic appendectomy, and umbilical hernioplasty. METHODS: The patient was admitted to the hospital's emergency room for abdominal pain in the epigastrium, transfixing, irradiating to both upper quadrants and to the lumbar region, accompanied by nausea and gastrobiliary vomiting. Lipase determination was 170 mg/dL. Other laboratory findings were normal. Plain abdominal films on the patient's admission were normal, and computed tomography (CT) showed data compatible with acute pancreatitis. Without improvement during the patient's hospital stay, pain and vomiting increased in intensity and frequency. RESULTS: New abdominal x-rays revealed dilatation of small bowel loops. Management was begun for intestinal obstruction, with intravenous hydration and placement of a nasogastric tube without a good response. At 48 hours, a diagnostic laparoscopy was performed, revealing a 3-cm internal hernia in the left broad ligament in which a 20-cm segment of terminal ileum was encased. We performed liberation of the ileal segment and closed the hernial orifice by using the laparoscopic approach. CONCLUSION: The patient's evolution was excellent.  (+info)