Negotiating and Coping with Complex Events of Practice and Difficult Conversations
A. O. Mahendran in Moments of Rupture: The Importance of Affect in Medical Education and Surgical Training, 2019
We were both scrutinizing the operating field. In this case it comprised a 35-year-old man’s lower abdomen, or groin (as commonly termed), and the contents of his spermatic cord (a rope-like structure that proceeds from the tissues of the lower abdomen to the testicles in the scrotum and carries the vas deferens, that is, a white tube that carries sperm). The scheduled operation was ‘surgical repair of an inguinal, or, groin hernia’. A hernia occurs due to a weakness in the abdominal wall, leading to the contents of the abdomen (such as bowel or fat) pushing through into the tissues of the groin. This typically presents as a protruding lump that is more prominent when standing, straining or coughing. However, 15 minutes into the operation, we were both stumped. We had identified the weakness in the wall and were trying to identify what exactly was herniating into the groin. What we found was a rather small, shrivelled, egg-like structure ensconced in the spermatic cord.
Hurler disease/mucopolysaccharidosis type IH (MPSIH)/α-L-iduronidase deficiency
William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop in Atlas of Inherited Metabolic Diseases, 2020
Shortness of stature is characteristic. Linear growth appears to stop at two to three years of age. Maximum height in one large series was 97 cm [13]; few exceed 100 cm. The neck is short, and the large head appears to rest directly on the thorax. The lower rib cage flares. The back is kyphotic, and there is a gibbus in the lower thoracic or upper lumbar area (see Figure 76.5). The joints become stiff, and mobility may be severely limited, especially at the elbows. The hands become broad, and the fingers stubby. This, and the limitation of extension and the position in flexion, produces the characteristic claw hand (Figure 76.8). The abdomen is protuberant. The liver and spleen become very large and very hard. Umbilical hernias are the rule, and inguinal hernias and hydroceles are common. Recurrence of a hernia is frequent following surgical repair. In a study on Hurler patients following hematopoietic stem cell transplantation there was a high incidence of pronated posture, foot and ankle disability, and a requirement for customized footwear [15].
Exercise and Aging
Maria A. Fiatarone Singh, John Sutton Chair in Exercise, Nutrition, and the Older Woman, 2000
The contraindications to exercise in this population are not different than those applicable to younger healthier adults.13 In general, frailty or extreme age is not a contraindication to exercise, although the specific modalities may be altered to accommodate individual disabilities.88 Acute illnesses, particularly febrile illnesses, undiagnosed or unstable chest pain, uncontrolled diabetes, hypertension, asthma, congestive heart failure, or new or undiagnosed musculoskeletal pain, weight loss, or falling episodes warrant investigation, regardless of exercise status, but certainly before a new regimen is begun. Sometimes temporary avoidance of certain kinds of exercise is required during treatment of hernias, cataracts, retinal bleeding, or joint injuries, for example. A very small number of untreatable or serious conditions are more permanent exclusions for vigorous exercise, including an inoperable enlarging aortic aneurysm, known cerebral hemorrhage or aneurysm, malignant ventricular arrhythmia, critical aortic stenosis, end-stage congestive heart failure or other rapidly terminal illness, or severe behavioral agitation in response to participation in exercise secondary to dementia, alcoholism, or neuropsychological illness. It should be noted, however, that the mere presence of cardiovascular disease, diabetes, stroke, osteoporosis, depression, dementia, chronic pulmonary disease, chronic renal failure, peripheral vascular disease, or arthritis is not by itself a contraindication to exercise. In fact, for many of these conditions, exercise will offer benefits not achievable through medication alone.
Novel understanding of high mobility group box-1 in the immunopathogenesis of incisional hernias
Published in Expert Review of Clinical Immunology, 2019
Nicholas K. Larsen, Matthew J. Reilly, Finosh G. Thankam, Robert J. Fitzgibbons, Devendra K. Agrawal
A hernia is defined as a defect in a body wall which allows for protrusion of an organ(s) through the body wall that typically contains it. Hernias of the abdominal wall are called ventral hernias and include umbilical, epigastric, incisional, and others. An incisional hernia (IH), the focus of this manuscript, develops as a complication of abdominal surgery and subsequent wound healing impairment. The incidence of the development of an incisional hernia after a laparotomy, a surgical incision into the abdominal cavity, is variously estimated, but on average is between 10% and 20%, but can be as high as 65% depending upon the patient population being studied, the type of surgery, and length and method of the follow-up [1]. This is because pathological processes such as diverticulitis and abdominal aortic aneurysms are highly prone to form an incisional hernia when they require surgical repair [2,3]. It is estimated that 100,000 to 150,000 ventral incisional hernia repairs are performed in the United States each year [4,5]. Further complicating the issue is the fact that after surgical repair, patients have an even greater risk of developing another incisional hernia, referred to as a recurrent incisional hernia, when compared to the incidence after the initial laparotomy [6].
Incisional Hernia Repair of Medium- and Large-Sized Defects: Laparoscopic IPOM Versus Open SUBLAY Technique
Published in Acta Chirurgica Belgica, 2019
Patrick Hamid Alizai, Eric Lelaona, Anne Andert, Ulf Peter Neumann, Christian Daniel Klink, Marc Jansen
Incisional hernia repair is among the most frequently performed surgical procedures. Although the use of new prosthetic mesh materials and operative techniques has improved abdominal wall hernia repair outcomes, postoperative complications remain an intractable problem. Over the past two decades, laparoscopic approach has become widely used for the repair of incisional hernias. Laparoscopic repair seems to provide acceptable outcomes in terms of morbidity, length of hospital stay, postoperative pain and recurrence rate [8]. However, most of the published studies include very heterogeneous type of hernias, varying from small, primary fascial defects to large incisional hernias. Small hernias can be repaired without substantial morbidity, but larger defect sizes are associated with increased postoperative complications [14]. The aim of this study was to evaluate if morbidity rates of laparoscopic repair compared to open surgery when larger defects are repaired. We therefore analyzed prospectively collected data of patients with medium- and large-sized incisional hernias according to the EHS classification [11]. Morbidity rate in patients who underwent SUBLAY was twice as high as in the IPOM group. Comparable to laparoscopic repair of small fascial defects, laparoscopic repair reduced the postoperative complications when applied to medium and large-sized defects. This is in line with a Cochrane collaboration report by Sauerland and colleagues, which found significantly less postoperative complications after laparoscopic hernia repair [8].
Acute pelvic inflammatory disease as a rare cause of acute small bowel obstruction
Published in Acta Chirurgica Belgica, 2019
Alexandre Haumann, Sarah Ongaro, Olivier Detry, Paul Meunier, Michel Meurisse
SBO is a common pathology in clinical practice. Postsurgical adhesions represent more than 75% of SBO causes [3]. Patients without any surgical history could present these symptoms secondary to hernia, internal hernia or neoplasm. In addition, in 10% of the cases, adhesions may result from infection or inflammatory disease (appendicitis, diverticulitis, endometriosis, PID, bowel intestinal disease, abdominal tuberculosis), chemical peritonitis and irritation resulting from a foreign body [2]. Pathophysiology of adhesions is well known [1]. Commonly, it is accepted that adhesions occur within 5–7 days after the peritoneal injury and progressively become organized with fibrotic tissues. Adhesions drive patients to be readmitted an average of two times over the subsequent 10 years for conditions related to them. SBO is not frequent in early adhesions.
Related Knowledge Centers
- Coelom
- Gastrointestinal Tract
- Groin
- Hiatal Hernia
- Inguinal Hernia
- Abdomen
- Development of The Digestive System
- Navel
- Femoral Hernia
- Incisional Hernia