Hernia - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R EFERENCES J AMES N. P ARKER , M...

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A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R EFERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright Ó2003 by ICON Group International, Inc. Copyright Ó2003 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Hernia: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-597-83706-6 1. Hernia-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on hernia. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications.

Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes & Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON HERNIA ..................................................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Hernia ......................................................................................... 10 E-Journals: PubMed Central ....................................................................................................... 31 The National Library of Medicine: PubMed ................................................................................ 32 CHAPTER 2. NUTRITION AND HERNIA ......................................................................................... 119 Overview.................................................................................................................................... 119 Finding Nutrition Studies on Hernia ........................................................................................ 119 Federal Resources on Nutrition ................................................................................................. 122 Additional Web Resources ......................................................................................................... 122 CHAPTER 3. ALTERNATIVE MEDICINE AND HERNIA ................................................................... 125 Overview.................................................................................................................................... 125 National Center for Complementary and Alternative Medicine................................................ 125 Additional Web Resources ......................................................................................................... 128 General References ..................................................................................................................... 130 CHAPTER 4. DISSERTATIONS ON HERNIA ..................................................................................... 131 Overview.................................................................................................................................... 131 Dissertations on Hernia ............................................................................................................. 131 Keeping Current ........................................................................................................................ 132 CHAPTER 5. CLINICAL TRIALS AND HERNIA ............................................................................... 133 Overview.................................................................................................................................... 133 Recent Trials on Hernia ............................................................................................................. 133 Keeping Current on Clinical Trials ........................................................................................... 134 CHAPTER 6. PATENTS ON HERNIA................................................................................................ 137 Overview.................................................................................................................................... 137 Patents on Hernia ...................................................................................................................... 137 Patent Applications on Hernia .................................................................................................. 167 Keeping Current ........................................................................................................................ 188 CHAPTER 7. BOOKS ON HERNIA ................................................................................................... 189 Overview.................................................................................................................................... 189 Book Summaries: Federal Agencies............................................................................................ 189 Book Summaries: Online Booksellers......................................................................................... 190 The National Library of Medicine Book Index ........................................................................... 195 Chapters on Hernia .................................................................................................................... 197 CHAPTER 8. MULTIMEDIA ON HERNIA ........................................................................................ 205 Overview.................................................................................................................................... 205 Video Recordings ....................................................................................................................... 205 Bibliography: Multimedia on Hernia......................................................................................... 206 CHAPTER 9. PERIODICALS AND NEWS ON HERNIA...................................................................... 209 Overview.................................................................................................................................... 209 News Services and Press Releases.............................................................................................. 209 Newsletter Articles .................................................................................................................... 213 Academic Periodicals covering Hernia ...................................................................................... 213 CHAPTER 10. RESEARCHING MEDICATIONS................................................................................. 215 Overview.................................................................................................................................... 215 U.S. Pharmacopeia..................................................................................................................... 215 Commercial Databases ............................................................................................................... 216 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 219 Overview.................................................................................................................................... 219

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NIH Guidelines.......................................................................................................................... 219 NIH Databases........................................................................................................................... 221 Other Commercial Databases..................................................................................................... 224 The Genome Project and Hernia ................................................................................................ 224 APPENDIX B. PATIENT RESOURCES ............................................................................................... 229 Overview.................................................................................................................................... 229 Patient Guideline Sources.......................................................................................................... 229 Associations and Hernia ............................................................................................................ 237 Finding Associations.................................................................................................................. 237 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 239 Overview.................................................................................................................................... 239 Preparation................................................................................................................................. 239 Finding a Local Medical Library................................................................................................ 239 Medical Libraries in the U.S. and Canada ................................................................................. 239 ONLINE GLOSSARIES ................................................................................................................ 245 Online Dictionary Directories ................................................................................................... 248 HERNIA DICTIONARY............................................................................................................... 249 INDEX .............................................................................................................................................. 311

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with hernia is indexed in search engines, such as www.google.com or others, a nonsystematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about hernia, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to hernia, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on hernia. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to hernia, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on hernia. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON HERNIA Overview In this chapter, we will show you how to locate peer-reviewed references and studies on hernia.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and hernia, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “hernia” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: ·

Short, Practical Guide to Hernias Source: Harvard Health. p. 6 January 2002. Contact: Harvard Health. P.O. Box 420300, Palm Coast, FL 32142-0300. (800) 829-9045. Website: www.health.harvard.edu/newsletters/subinfo.html. Summary: Abdominal hernia is the more accurate term for what most people simply call a hernia: contents of the abdomen push through a weak area in the abdominal wall. Those contents can include segments of the large and small intestine, the ovaries, and the bladder. This brief newsletter article familiarizes readers with abdominal hernias and hernia repair. The article covers a definition of terms, causes and prevention, symptoms, non-surgical options, and surgery. One illustration depicts the typical abdominal hernia before and after surgical repair.

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Congenital Diaphragmatic Hernia: A Physiologic Approach to Management Source: Journal of Peritoneal Neonatal Nursing. 3(3): 66-79. January 1990. Summary: Congenital diaphragmatic hernia (CDH) is an anatomically simple defect that is surgically correctable by removing the herniated viscera from the thorax and repairing the diaphragm. Although it is anatomically simple, the mortality associated with CDH is 50 to 80 percent, despite improvements in prenatal diagnosis, resuscitation, preoperative and postoperative stabilization, and ventilatory management. This article presents a physiologic approach to the management of CDH. The author discusses the anatomic and functional developmental abnormalities associated with CDH, prenatal and postnatal diagnosis, resuscitation, and preoperative stabilization of these infants. In addition, the methods of surgical correction, the primary care concerns in postoperative management, and the long-term outcome for survivors of CDH repair are also addressed. 5 figures. 41 references. (AA-M).

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Excess Gastroesophageal Reflux in Patients with Hiatus Hernia Is Caused by Mechanisms Other Than Transient LES Relaxations Source: Gastroenterology. 119(6): 1439-1446. December 2000. Contact: Available from W.B. Saunders Company. 6277 Sea Harbor Drive, Orlando, FL 19106-3399. (800) 654-2452 or (407) 345-4000. Summary: Esophageal acid exposure is higher in patients with gastroesophageal reflux disease (GERD) with hiatus hernia that in those without hernia. This article reports on a study that investigated the effect of a sliding hiatus hernia on the mechanisms underlying spontaneous gastroesophageal reflux (return of stomach acid back up the esophagus) over 24 hours. Twelve GERD patients with and 10 GERD patients without hiatus hernia were studied for 24 hours. Combined esophageal pH and manometric recordings of the pharynx, lower esophageal sphincter (LES), and stomach were performed. Results showed that patients with hiatus hernia had greater esophageal acid exposure (7.6 percent versus 3.3 percent) and more reflux episodes (3.1 versus 1.8) than those without hernia. LES pressure, the incidence of transient LES relaxations (TLESRs), and the proportion of TLESRs associated with acid reflux were comparable in both groups. Both groups had equal numbers of reflux episodes associated with TLESRs and swallow associated prolonged LES relaxations. Patients with hiatus hernia had more reflux associated with low LES pressure, swallow associated normal LES relaxations, and straining during periods with low LES pressure. The authors conclude that the excess reflux in GERD patients with hiatus hernia compared with those without hernia is caused by malfunction of the gastroesophageal barrier during low LES pressure, swallow associated normal LES relaxations, deep inspiration, and straining. 5 figures. 2 tables. 43 references.

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Acid-Induced Esophageal Shortening in Humans: A Cause of Hiatus Hernia? Source: Canadian Journal of Gastroenterology. 14(10): 847-850. November 2000. Contact: Available from Pulsus Group, Inc. 2902 South Sheridan Way, Oakville, Ontario, Canada L6J 7L6. Fax (905) 829-4799. E-mail: [email protected]. Summary: Hiatus hernia and gastroesophageal reflux disease (GERD) commonly coexist, and there is pathophysiological evidence that the presence of a hiatus hernia contributes to abnormal acid reflux (return of the stomach's gastric acid to the esophagus). However, the cause of hiatus hernia remains unclear. This article reports on a study undertaken to determine whether luminal acid produces esophageal shortening

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in humans (to replicate previous studies that demonstrated in animals how acute acid injury to the esophagus results in esophageal shortening and perhaps hiatus hernia). Twelve volunteers were each studied on two occasions, 1 week apart, in a double blind, crossover trial. The location of the lower esophageal sphincter (LES), as well as the LES resting pressure and axial length were determined at baseline and then again after 20 minutes of either acid or saline perfusion. Results showed that acid perfusion did not induce significant changes in resting LES pressure but resulted in proximal migration of the LES (i.e., esophageal shortening) by an average of 0.5 cm, with the largest proximal migration being 1.8 cm. In contrast, saline perfusion resulted in slight distal migration of the LES (i.e., esophageal lengthening). The authors conclude that intraluminal acid perfusion caused longitudinal axis shortening of the esophagus and suggests that gastroesophageal acid reflux may contribute to the cause of hiatus hernia. 4 figures. 19 references. ·

Inguinal Hernia Repair in Adults Source: Lancet. 344(8919): 375-379. August 6, 1994. Summary: In this article, the authors provide guidelines for the treatment of inguinal hernia, combining the results of recent published work with their own personal experience. They note that the addition of mesh procedures and the recent introduction of laparoscopic surgery have not solved earlier controversies; instead, they provoke discussion about the procedure of choice. Topics include epidemiology; pathophysiology; classification of hernia; diagnosis; indications for surgery; anesthesia; surgical technique; and complications. 1 figure. 2 tables. 51 references. (AA-M).

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Paraduodenal Hernia: A Treatable Cause of Upper Gastrointestinal Tract Symptoms Source: Journal of Clinical Gastroenterology. 31(3): 226-229. October 2000. Contact: Available from Lippincott Williams and Wilkins, Inc. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-3030 or (301) 714-2300. Summary: Paraduodenal hernia (PDH) is an unusual condition that is caused by congenital (present at birth) intestinal malrotation and that results in small intestinal obstruction. Noncatastrophic presenting symptoms and their responses to surgery have not been well characterized. This article reports on a study in which barium upper gastrointestinal (UGI) series and small bowel followup x-rays, performed from December 1995 to September 1996, were sequentially reviewed to identify patients with small bowel series compatible with a PDH. Case histories were reviewed for symptomatic presentation, associated evaluation, and treatment. Based on the 294 UGIs and small bowel followthroughs performed during this 10 month period, 6 cases were suspected to have a PDH. A right PDH was confirmed in the three patients who underwent surgical exploration (prevalence 1 percent). Preoperative patient symptoms included nausea, bilious vomiting, and right upper quadrant pain. Repair of the hernia defect resulted in complete resolution of chronic symptoms. Preoperative upper endoscopy, performed in three patients, was not helpful in identifying the disorder. Preoperative computerized tomography obtained in two patients was diagnostic for a right PDH. One symptomatic patient with vomiting and gastric stasis did not have surgery because of a terminal illness. The remaining two patients had no symptoms attributable to PDH. The authors conclude that patients with PDH frequently have chronic UGI symptoms. An upper endoscopy cannot be used to exclude this entity. After surgery, UGI symptoms from PDH are likely to resolve. 5 figures. 18 references.

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Management of Patients with Giant Paraesophageal Hernia Source: Diseases of the Esophagus. 11(3): 177-180. July 1998. Contact: Available from Harcourt Brace and Company, Ltd. Journal Subscription Department. Foots Cray, Sidcup, Kent, DA 14 5HP. Summary: Paraesophageal herniation can cause massive bleeding, strangulation, or perforation. This article reports on a study that reviews the experience with 24 patients (average age 74.6 years, range 63 to 89 years; 20 men, 4 women) with total or near total intrathoracic stomach, managed at the Royal Lancaster Infirmary (Lancaster, United Kingdom). All patients were symptomatic with 3 of 24 presenting as emergencies. A total of 23 patients underwent surgery: gastropexy alone (5 patients), gastropexy and hiatal repair (17 patients), and gastropexy, hiatal repair and fundoplication (1 patient). One of the emergency patients died before surgery. Median operative time was 50 minutes (range 35 to 65 minutes), and median hospital stay was 7 days (range 5 days to 3 weeks). A splenectomy was necessary in 1 of 23 patients (4.3 percent). Postoperative morbidity included recurrent hernia requiring surgery, pleural effusion requiring a chest tube, empyema, dysphagia requiring dilatation, and reflux with stricturing (1 patient for each complication). The authors conclude that older patients with a total or a near total intrathoracic stomach can be managed by gastropexy and hiatal repair, with acceptable morbidity; gastropexy alone should be avoided. This study also demonstrates the serious complications of paraesophageal herniation in an older population. 2 figures. 2 tables. 11 references. (AA-M).

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Morgagni Hernias: An Uncommon Cause of Chest Masses in Adults Source: American Family Physician. 54(6): 2021-2024. November 1, 1996. Summary: This article describes Morgagni hernia, a congenital diaphragmatic hernia that occurs secondary to potential anterior medial defects in the diaphragm. While Morgagni hernias may develop secondary to incomplete development of the diaphragm, other associated factors include trauma, severe effort, and obesity. Although the hernia usually is diagnosed incidentally, appearing as a mass on a chest radiograph, symptoms of bowel obstruction may occur. Surgical repair is required in all cases and may be performed with either the abdominal or transthoracic approach. The results of surgical repair of Morgagni hernias are excellent, with negligible morbidity and mortality and extremely low rates of recurrence. The authors describe an illustrative case of a 37-year-old man with a Morgagni hernia. 3 figures. 12 references. (AA-M).

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Congenital Diaphragmatic Hernia: Implications for Nitrous Oxide Use in Dentistry Source: Special Care in Dentistry. 13(3): 107-109. 1993. Summary: This article describes the development of diaphragmatic hernias, their associated physical and diagnostic signs and symptoms, and the potential complications with nitrous oxide use and provides a case report. Depending upon the location and extent of the diaphragmatic defect, portions of the stomach, omentum, liver and/or intestine can occupy a portion of the thoracic cavity. Nitrous oxide's solubility properties allow for rapid expansion of the herniated bowel, resulting in compression of the thoracic organs or strangulation of the herniated abdominal viscera. The authors note that the presence of a diaphragmatic hernia may necessitate a change in sedation or anesthesia plans to eliminate the use of nitrous oxide during prolonged procedures. 3 figures. 13 references. (AA-M).

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Diaphragmatic Hiatal Hernias: Recognizing and Treating the Major Types Source: Postgraduate Medicine. 88(1): 113-114, 117-120, 123-124. July 1990. Summary: This article provides a comprehensive review of the two main types of diaphragmatic hiatal hernias, sliding hiatal hernia and paraesophageal hernia, including the underlying causes, useful diagnostic studies, and preferred treatment. The pathophysiology and treatment of herniations through the esophageal hiatus remain controversial. For the majority of patients with a sliding hiatal hernia, medical treatment is preferred. Because of the high rate of treatment failure after the onset of complications for paraesophageal hernia, elective surgical repair is advisable in all patients, even those without symptoms. Definitive surgical treatment consists of reduction of the hernia, excision of the sac, and partial closure of the widened hiatus anterior to the esophagogastric junction. 5 figures. 21 references. (AA-M).

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Survey of Hiatus Hernia: Newly Developing Hiatus Hernia: A Survey in Patients Undergoing Upper Gastrointestinal Endoscopy Source: Journal of Gastroenterology and Hepatology. 17 (5): 542-544. May 2002. Contact: Available from Blackwell Science. 54 University Street, Carlton South 3053, Victoria, Australia. +61393470300. Fax +61393475001. E-mail: [email protected]. Website: www.blackwell-science.com. Summary: This article reports on a cross sectional study that was performed in a large population of consecutive patients undergoing endoscopy in order to assess the yearly incidence of hiatal hernia in this population. Consecutive patients undergoing upper gastrointestinal endoscopy in whom no macroscopic abnormalities were seen and who, in addition, underwent a second endoscopy were included in the study. The presence of newly developed hiatus hernia was noted, as well as the time elapsed between both endoscopies. Over a period of 8 years, 12,122 endoscopies were performed in 9,580 patients. Ninety patients developed a hiatus hernia; this was not the case in a control group of 353 patients. Patients who developed a hiatus hernia were significantly older than those who did not. The number of women who developed hiatus hernia was higher than the number of men who developed hiatus hernia. The authors calculate that 19.9 percent of the studied population would develop a hiatus hernia per year. 1 figure. 1 table. 9 references.

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Management of Giant Paraesophageal Hernia Source: Diseases of the Esophagus. 10(1): 47-50. January 1997. Summary: This article reports on a retrospective study in which the records of 51 patients operated on for giant paraesophageal hiatal hernia were reviewed. The authors compare the transthoracic and transabdominal approaches and assess the value of a concomitant fundoplication. Operative repair was performed using open transthoracic, transabdominal, and thoracoabdominal approaches. Laparoscopic techniques were used in one patient. Fundoplication was performed in 45 patients. There was no operative mortality, but early postoperative complications occurred in 29 percent of patients. The presence of commonly associated symptoms was used to derive preoperative and postoperative symptom scores. Followup was available in 48 patients. Excellent results were reported in 69 percent of patients and 17 percent had good results. The symptom score improved significantly regardless of the operative approach selected or whether a fundoplication was performed. The authors conclude that outcome after paraesophageal

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hiatal hernia repair is satisfactory in most patients, irrespective of the route chosen or techniques used for repair. 3 tables. 17 references. (AA). ·

Prospective Study of the Outcome for Fetuses With Diaphragmatic Hernia Source: Journal of the American Medical Association. JAMA. 217(5): 382-384. February 2, 1994. Summary: This article reports on a study undertaken to investigate the natural history and outcome of isolated congenital diaphragmatic hernia (CDH) diagnosed before birth. The authors note that the mortality of CDH with currently available postnatal care, including extracorporeal membrane oxygenation (ECMO), reported in retrospective studies ranges from less than 25 percent to greater than 75 percent. The population consisted of 83 fetuses with isolated, potentially correctable CDH diagnosed prior to 24 weeks' gestation referred to the University of California, San Francisco, Fetal Treatment Center between January 1989 and October 1993. In this study, the mortality for potentially correctable CDH diagnosed before 24 weeks' gestation is 58 percent, despite optimal care presently available after birth. The authors mention that infants who die in utero and soon after birth constitute a substantial hidden mortality. 1 figure. 1 table. 21 references. (AA-M).

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Laparoscopic Repair of Paraesophageal Hiatal Hernias Source: Journal of the American College of Surgeons. 186(4): 428-432. April 1998. Summary: This article reports the University of California (UC) at San Francisco's experience with laparoscopic repair of paraesophageal hiatal hernias, emphasizing the technical steps essential for good results. From May 1993 to September 1997, 55 patients (27 women, 28 men, mean age 67 years) underwent laparoscopic repair of paraesophageal hernias at the UC facility. Symptoms, which had been present an average of 85 months before surgery, consisted mainly of pain (55 percent), heartburn (52 percent), dysphagia (45 percent), and regurgitation (41 percent). Of the four patients who presented with acute illness, two had gastric obstruction, one had severe dyspnea, and one had gastric bleeding. Endoscopy demonstrated esophagitis in 25 (69 percent) of 36 patients, and 24 hour pH monitoring demonstrated acid reflux in 22 (67 percent) of 33 patients. Manometry detected severely impaired distal esophageal peristalsis in 17 (52 percent) of 33 patients. The preferred operation consisted of reduction of the hernia, excision of the sack and the gastric fat pad, closure of the enlarged hiatus without mesh, and construction of a fundoplication anchored by sutures within the abdomen. Of the 55 patients, the operations of 49 were completed laparoscopically; five (9 percent) were converted to laparotomies. The average operating time was 219 minutes; the average blood loss was less than 25 mL; resumption of an unrestricted diet occurred after 27 hours; and mean hospital stay was 58 hours. Intraoperative technical complications occurred in five (9 percent) patients. One patient died during surgery from a sudden pulmonary embolus; two patients (4 percent) required a second operation for recurrent paraesophageal hernias. The authors conclude that laparoscopic repair of paraesophageal hiatal hernias is safe and effective, but the operation is difficult and good results hinge on details of the operative technique and the surgeon's experience. 2 figures. 1 table. 21 references. (AA-M).

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Surgical Options in the Management of Groin Hernias Source: American Family Physician. 59(1): 143-156. January 1, 1999.

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Contact: Available from American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237. Website: www.aafp.org. Summary: This article reviews the surgical options used to manage groin hernias. Inguinal and femoral hernias are the most common conditions for which primary care physicians refer patients for surgical management. Hernias usually present as a swelling accompanied by pain or a dragging sensation in the groin. Most hernias can be diagnosed on the basis of history and clinical examination, but ultrasonography may be useful in differentiating a hernia from other causes of swelling. Surgical repair is usually advised because of the danger of incarceration and strangulation, particularly with femoral hernias. Three major types of open repair are currently used, and laparoscopic techniques are also employed. The choice of technique depends on several factors, including the type of hernia, anesthetic considerations, cost, period of postoperative disability, and the surgeon's expertise. Following initial herniorrhaphy, complication and recurrence rates are generally low. Laparoscopic techniques make it possible for patients to return to normal activities more quickly, but they are more costly than open procedures. In addition, they require general anesthesia, and the long term recurrence rate with these procedures is not known. 8 figures. 4 tables. 27 references. (AA). ·

Terry's Topics: Parastomal Hernia Source: Metro Wash By-Pass. 98(68): 4. October 1991. Contact: Available from United Ostomy Association. Metropolitan Washington Chapter, Washington Hospital Center, East Building, Room 3102, 110 Irving Street, N.W., Washington, DC 20010. (202) 877-6019. Summary: This brief article, from a newsletter for people with ostomies, discusses parastomal hernias. A parastomal hernia may result from a weakness in the abdominal muscles around or near a stoma. The bulge may contain loops of colon or small intestine. The author discusses possible problems arising from a parastomal hernia, equipment changes that may become necessary, and treatment options, including surgery and an ostomy hernia belt.

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Impact of Omeprazole and Laparoscopy Upon Hiatal Hernia and Reflux Esophagitis Source: Journal of the American College of Surgeons. 183(4): 413-418. October 1996. Summary: This review article analyzes the treatment successes on hiatal hernia and reflux esophagitis that are attributable to omeprazole and laparoscopy. Both approaches challenge the accepted multimodal, nonoperative therapy of the past two decades and the reproducible efficacy of the open fundoplication procedure. As a proton pump blocker, omeprazole decreases gastric acidity by directly blocking acid production. Omeprazole has a long duration of acid suppression that does not appear to affect gastroesophageal sphincter function or gastric motility. However, long-term use of omeprazole is questionable in terms of both safety and efficacy. The authors note that operative therapy, especially if minimally invasive (as in laparoscopy) is being more widely practiced. Laparoscopic Nissen fundoplication (LNF) has proved to be a very safe operation overall and the principles of reconstruction of the lower esophageal sphincter, which have been learned from open techniques, can be strictly maintained with the minimally invasive approach. The authors conclude with a call for additional studies to fully evaluate the clinical effectiveness of LNF and to define the 'learning curve' required for physicians. 6 tables. 46 references.

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Federally Funded Research on Hernia The U.S. Government supports a variety of research studies relating to hernia. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to hernia. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore hernia. The following is typical of the type of information found when searching the CRISP database for hernia: ·

Project Title: A BIOSCAFFOLD FOR REPAIR OF CONGENITAL DEFECTS Principal Investigator & Institution: Spievack, Alan R.; Acell, Inc. 6 Old Dee Rd Cambridge, Ma 02138 Timing: Fiscal Year 2001; Project Start 01-AUG-2001; Project End 31-JAN-2002 Summary: (Verbatim from the Applicant's Abstract): This Phase I SBIR application seeks support to develop and evaluate a naturally-occurring extracellular matrix (ECM) bioscaffold material for tissue engineering applications; specifically, the repair and/or restoration of congenital defects in which lost or missing tissue is the limiting factor for surgical reconstruction. Porcine derived ECM harvested from the urinary bladder (UBM) represents a cellular biodegradable scaffold material that supports cell attachment, migration, proliferation and differentiation, and wound healing. Processed single sheets of UBM and other ECMs have shown excellent remodeling capabilities in both pre clinical animal studies and early human clinical studies. With SBIR Phase I support, we propose to develop a multilaminate sheet form of UBM with the appropriate mechanical and biologic properties that allow for post surgical tissue growth and thus obviate the need for repeat surgeries as the patient matures. An experimentally-created diaphragmatic hernia will be used as the model of a congenital defect. There are three specific aims. First, we will determine the manufacturing method required to develop a prototype multilaminate UBM device with the mechanical strength that exceeds by a factor of 2 the normal mammalian diaphragm. Secondly, we will evaluate the effect of two different methods of sterilization, gamma irradiation and ethylene oxide, upon the mechanical strength of the prototype UBM device. The third specific aim will evaluate the utility of the sterilized multilaminate UBM device in a dog pilot study in which an experimentally-created diaphragmatic hernia will be repaired in 10-weekold dogs and evaluated over time until the point of physical maturity. Currently, there are limited options for the surgical repair/reconstruction of body structures that require surgical repair as a result of congenital abnormalities. The proposed studies are critical in the decision-making process of determining whether or not to pursue development of this product. Each objective/specific aim has well-defined

2 Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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criteria for success, and the proposed studies will be conducted by an experienced and knowledgeable tissue engineering research team. A time line for the proposed work is provided, and the technology involves an innovative tissue engineering approach in a medical field with significant unmet needs. PROPOSED COMMERCIAL APPLICATION: The use of UBM-ECM for the tissue engineering applications that involve the restoration of missing tissue as a result of congenital anomalies is in many ways an orphan market. Most biomaterials currently available for such use are inadequate beause they do not "grow" as the infant grows and, thus, repeat surgical procedures are required. Many currently available materials result in scar tissue formation with extensive morbidity. The development of new materials for these applications is not cost effective for many large companies due to the relatively small number of patients requiring this material each year. However, these patients desperately need a better alternative to existing materials, and successful development of this product could lead to broader surgical applications. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: A SHEAR FORCE TRANSFER COUPLING FOR SOFT TISSUE REPAIR Principal Investigator & Institution: Byrne, Mark T.; Cardioenergetics, Inc. 3130 Highland Ave, 3Rd Fl Cincinnati, Oh 45219 Timing: Fiscal Year 2003; Project Start 01-SEP-2003; Project End 31-AUG-2004 Summary: (provided by applicant): This project will demonstrate feasibility of a new wound closure concept based on shear force transfer - the familiar way in which root tendrils resist being pulled from soil. This is a distinctly different mechanism of action from conventional sutures and staples. Suture closure of surgical or traumatic wounds typically fails absent adequate fibrous tissue in which to place those sutures. Sites ranging from abdominal walls to uteri to severed limbs to cardiac valve annuli can be very problematic. The wounds may either outright separate (dehisce) in a few hours or days--an often life-threatening condition--or they may stretch into a progressively more disabling incisional hernia. We have patented wound closure technology based on this principle and relevant experience developing it for commercial applications. The principle investigator is presently directing an SBIR Phase II applying this principle for cardiac power. The scientific director invented the device and directed validating muscle-prosthetic bonding application evaluations. The research engineer has fabricated devices both for some of these rabbit studies and for a successful canine trial of the cardiac power device by another institution. Our initial work to apply the technology to the problem of a durable load bearing muscle to prosthetic coupling for circulatory support has succeeded. Work to solve orthopaedic fixation problems is ongoing. There is no reason why a device applying this same mechanical principle to load-bearing bonds between soft tissues should not succeed. We propose developing a device, the FiberSecure, for bonding soft-tissue to soft tissue. It will employ a myriad of ultrafine polymer fibers, which disperse to maximize surface contact for minimal implanted bulk. After development, we will demonstrate device feasibility by testing the hypothesis that FiberSecure wound closure is stronger than conventional suture closure. We will use an established wound-healing experimental model: midline laparotomy in New Zealand White rabbits, modified by removal of adjacent fascial sheath. Control procedure is muscle-to-muscle approximation by conventional suturing. Testing is by histology and pull strength at 21 days. The experimental data will be tested for significance using the Student's t-test. Effective demonstration of feasibility would position the FiberSecure as

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the closure device of choice for difficult wounds in multiple surgical specialties and pave the way for recruiting a commercialization partner for our Phase II SBIR proposal. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: ADVANCING CLINICAL RESEARCH IN PEDIATRIC SURGERY Principal Investigator & Institution: Lally, Kevin P.; Surgery; University of Texas Hlth Sci Ctr Houston Box 20036 Houston, Tx 77225 Timing: Fiscal Year 2002; Project Start 01-JUN-2002; Project End 31-MAY-2007 Summary: Congenital disorders requiring major pediatric surgical intervention are infrequent and present complex management problems. Most pediatric surgical studies are methodologically weak, single-center studies, and improved outcomes are likely to require a series of multi-center studies of exemplary quality. The applicant, Dr. Kevin Lally, the A.G. McNeese Professor and Chief of Pediatric Surgery at UT Houston, is a leader in promoting such studies. He has participated in 19 diaphragmatic hernia (CDH). CDH occurs in 1 per 2-4,000 live births; 35% of infants die; survivors are ventilated a mean of 18 days; and 34% have chronic lung disease. K24 funding is requested to substantially increase Dr. Lally's time for 1) Clinical Research including: a) A Multi-center placebo- controlled, randomized trial of antenatal steroids for infants with prenatally diagnosed CDH to improve their oxygenation and reduce time to ventilator independence. Fifteen centers have committed to participate; 7 have IRB approval; and 8, including UT-Houston, have GCRCs. The UT-Houston GCRC provides substantial statistical and database support for this trial. Collaborators at UT Houston include Drs. Larry Gilstrap and Jon Tyson, both experienced in steroid trials, and wellfunded investigators in steroid trials, and well-funded investigators in the NICHD Maternal-Fetal and Neonatal Research Networks; and b) Extensive analyses of the CDH registry to define improved predictors of outcome, assess geographic differences and temporal trends, and develop hypotheses and descriptive data needed to design trials to improve outcome. This database has strict quality control, data on 1650 infants and 48 institutions now participate. 2) Mentoring Dr. Lally is a talented mentor; 3 current mentees have recently received a K08 award, a K23 award, and a Young Investigator Award. To enhance his mentoring skills, promote the funding and productivity in his Division of Pediatric Surgery, and augment his methodologic skills in clinical research, Dr. Lally will complete the NIH funded Clinical Research Curriculum work and assist with mentoring teams for young investigators in the Curriculum. He will also conduct systematic reviews of the Cochrane Collaboration and complete the Master's Degree Program in Clinical Research at UT-Houston. K24 funding will help Dr. Lally with his research and mentoring to advance the quality of clinical research in pediatric surgery, develop an expanded international trials network, and improve the outcome of highrisk infants. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: ANATOMIC AND MECHANICAL VARIABLES OF THE EGJ IN GERD Principal Investigator & Institution: Pandolfino, John E.; Medicine; Northwestern University Office of Sponsored Programs Chicago, Il 60611 Timing: Fiscal Year 2002; Project Start 01-JUL-2002; Project End 30-JUN-2007 Summary: (provided by applicant): The long-term objective of this research proposal is to understand the role of anatomical and mechanical variables of the esophagogastric junction (EGJ) in the pathogenesis of gastroesophageal reflux disease (GERD). The

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candidate is currently in the first year of a tenure track faculty appointment in the Division of Gastroenterology and Hepatology at Northwestern University Medical School. He is seeking support for full time mentored research. His mentor, Dr. Peter Kahrilas is an NIH funded internationally-recognized expert on esophageal physiology and division head in the department of Gastroenterology and Hepatology. In addition, the candidate will be enrolled in the K30 sponsored Master of Science in Clinical Investigation Program at the Graduate School of Northwestern University. The proposed research study is to define the anatomical and mechanical variables of the EGJ as they relate to GERD. The EGJ is a complex anatomic zone whose functional integrity is sum of its many parts. To date, much of the research on the competence of the EGJ in GERD has been focused on the lower esophageal sphincter. Our hypothesis is that acquired anatomic changes inclusive of, but not restricted to hiatal hernia may alter the mechanical characteristics of the EGJ and affect the propensity to reflux. One such variable that will be studied is compliance. Increased compliance may exacerbate reflux in two ways: 1) lowering the incremental increase in intra-abdominal pressure required to open the relaxed or hypotensive EGJ, and 2) the relaxed EGJ may open wider than normal under a given physiological circumstance resulting in a reduced discriminative resistance for liquid as opposed to gas reflux. Compliance will be determined using a customized barostat technique and then correlated with hiatal hernia size, intraabdominal LES length, angle of His and gastroesophageal flap valve grade. In addition, we will be attempting to improve standard pH monitoring technique by measuring acid exposure at the SCJ and converting data to hydrogen ion concentration exposure. These changes will improve diagnostic accuracy of pH monitoring and also help determine the relationship between anatomical and mechanical variants and acid reflux. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: BEHAVIORAL EFFECT OF OBSTRUCTIVE SLEEP APNEA IN CHILDREN Principal Investigator & Institution: Chervin, Ronald D.; Associate Professor and Director; Neurology; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, Mi 481091274 Timing: Fiscal Year 2001; Project Start 01-AUG-1999; Project End 31-JUL-2003 Summary: Adenotonsillectomy (AT) remains one of the most common surgical procedures performed in children, but indications for AT have changed in recent years. Surgeons now perform AT in many instances for suspected obstructive sleep-disordered breathing (SDB), and sometimes for daytime behaviors that may be a consequence of SDB, especially inattention and hyperactivity. However, whether SDB causes these and other disruptive behaviors, the precise nature of these behaviors, and what types or levels of SDB may be of concern are not well known. Without such knowledge, pediatricians and otolaryngologists do not often make use of objective preoperative testing that could help to assess for SDB or abnormal behavior. The main goals of the research described in this proposal are to (1) better define whether inattention and hyperactivity are frequent among children who undergo AT, (2) identify measures and levels of SDB that are indicative of these behaviors, (3) test whether improvement in SDB after AT is associated with improvement in behavior, and (4) investigate the hypothesis that SDB is a cause of inattention, hyperactivity, and related behaviors in some children. Subjects will be 5 through 12 year-old children recruited after they have been scheduled by their physicians for AT (n = 200) or hernia repair (n = 75 controls). A battery of well-validated behavioral assessment tools, cognitive tests, and structured psychiatric interviews will be used before surgery to define what behaviors are more

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prominent in the children scheduled for AT rather than hernia repair. All children will undergo preoperative polysomnography which will include, for the first time in such a series, equipment that can detect subtle forms of SDB which may be particularly prevalent in children. Results will allow determination of what polysomnographic findings are associated with well-defined adverse behavioral outcomes. Finally, preoperative and postoperative testing in these subjects will provide a controlled nonrandomized trial of AT for SDB, demonstrate whether SDB-associated abnormal behaviors improve after AT, and provide strong evidence for whether SDB is a cause of these behaviors. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: BIOMEDICAL EFFECTS OF JOHREI RECOVERY FROM SURGERY Principal Investigator & Institution: Hamilton, Allan J.; University of Arizona P O Box 3308 Tucson, Az 857223308 Timing: Fiscal Year 2002; Project Start 01-JUL-2001; Project End 30-JUN-2004 Summary: (provided by the applicant): Johrei is a biofield therapy established in Japan that is purportedly derived from techniques thousands of years old. Johrei is practiced in centers worldwide, and claims that it can serve as a complementary medicine modality, to enhance recovery from surgery. As part of the Center for Frontier Medicine in Biofield Science, this collaborative three-year project is designed to determine if Johrei, practiced proximally (at the bedside) or distally (away from the patient), has effects that can documented clinically, psychophysiologically, and biophysically. Two studies are proposed. Study 1 (primary) is an exploratory, double-blind distal clinical Johrei experiment examining recovery from elective surgery (hernia and coronary bypass) on subjective pain, anxiety and depression, use of pain medication, wound healing, medical complications, and patient satisfaction, as well as on physiological recovery (as indexed by heart rate variability) in coronary bypass surgery patients. Study 2 (secondary) is an exploratory, non-blind proximal basic science and clinical Johrei experiment examining measures of ECG and EEG in practitioners and patients as possible psychophysiological and biophysical markers of recovery from elective surgery. In Study 1, hernia patients (N=60) and coronary bypass patients (N=60) will be randomly assigned to receive Johrei therapy. Both the patients and the hospital staff will be blind to which patients receive Johrei. Distal Johrei will be provided twice a day (a) 3 days before surgery, (b) during surgery, and (c) 3 days after surgery. To assess changes in heart rate variability in coronary bypass surgery patients, ECG measures of recovery will be obtained on day 4 pre-operative (before Johrei therapy in the Johrei group), and days 3, 14, and 28 post-operative. In addition to regular clinical outcome measures, patient's beliefs about CAM therapy before and after surgery will be ascertained. The specific hypothesis is that distal Johrei will have significant effects on measures of recover) front surgery, and this effect may be amplified in patients most open to receiving CAM assistance. In Study 2 (run in parallel), a separate sample of hernia patients (N=60) and coronary bypass patients (N=60) will be randomly assigned to receive proximal Johrei therapy. The therapy will be provided twice a day for 3 days after surgery. ECG and two sites of EEG will be simultaneously recorded from the practitioner and the patient. Established measures of heart rate variability, and EEG spectral analysis, as well as innovative measures of ECG-EEG synchrony within and between practitioner and patient. will be assessed. The specific hypothesis is that proximal Johrei will have significant effects on measures of recovery front surgery, and that this effect will be strongest in patients who show the greatest increases in heart rate variability, EEG alpha-theta, and practitioner/patient ECG-EEG synchrony. This will be

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the first comprehensive project to evaluate the potential CAM effects of a biofield therapy in recovery from surgery as well as explore the application of psychophysiological marker; to document the purported physiological and biophysical interaction effects resumed to occur in biofield therapies. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: DIETARY OMEGA-3 FATTY ACIDS, GENE EXPRESSION AND GROWTH Principal Investigator & Institution: Heird, William C.; Professor; Pediatrics; Baylor College of Medicine 1 Baylor Plaza Houston, Tx 77030 Timing: Fiscal Year 2001; Project Start 30-SEP-1999; Project End 31-AUG-2003 Summary: Dietary omega3 fatty acids have been associated with higher rates of energy expenditure, lower rates of weight gain and/or lower rates of fat deposition in rodents as well as human infants and adults. These fatty acids also have been shown to inhibit transcription of genes encoding rate-limiting enzymes of lipogenesis and to enhance transcription genes encoding rate- limiting enzymes for mitochondrial and peroxisomal oxidation as well as the skeletal muscle content of the putative thermogenic uncoupling protein (UCP)-2. Studies are proposed to determine if the metabolic and genomic events occur in a concerted way in vivo to increase energy expenditure and, hence, decrease rates of fat deposition and weight gain as well as to explore specific cellular and nuclear mechanisms by which the effects of omega3 fatty acids are mediated. Clinical studies, to be conducted in 3-6-month-old infants scheduled for surgical repair of inguinal hernia, will address the hypothesis that omega3 fatty acids regulate gene expression so as to decrease a rate-limiting enzyme of triglyceride synthesis (i.e., glycerol-3-phosphate acyltransferase), increase the rate-limiting enzymes of mitochondrial (i.e., carnitine palmitoyl transferase) and peroxisomal fatty acid oxidation (i.e.,acyl-CoA oxidase) and increase abundance of UCP-2 and/or-3 resulting in greater energy expenditure secondary to the inefficiency of enhanced peroxisomal and/or uncoupled mitochondrial oxidation. Infants will be assigned randomly and blindly to formulas that differ only in alpha-linolenic acid (either 1 percent or 4 percent of total fatty acids) and muscle will be obtained approximately two weeks later, during the scheduled operation, for assay of the mRNA abundance of the cited transcripts. Energy expenditure will be determined at the same time by indirect calorimetry and correlated with mRNA abundances. Studies to be conducted in rats will examine the hypothesis that omega3 fatty acids decrease production of malonyl-CoA, an inhibitor of carnitine palmitoyl transferase, by decreasing expression of and/or inactivating the rate-limiting enzyme for its synthesis, i.e., acetyl-CoA carboxylase. Other studies in rats will utilize DNAse hypersensitivity and in vivo footprinting assays to identify DNA regions in the UCP-2, UCP-3 and acetyl-CoA oxidase genes that are targets for omega3 fatty acid regulation. In toto, the proposed studies will identify molecular and cellular mechanisms by which omega3 fatty acids govern the expression of genes encoding key enzymes of lipid metabolism and the extent to which these effects impact whole body energy expenditure and, hence, rates of fat deposition and weight gain. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: EFFECTS OF PHYSICAL STIMULI ON FETAL LUNG DEVELOPMENT Principal Investigator & Institution: Kitterman, Joseph A.; Professor of Pediatrics; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 94122 Timing: Fiscal Year 2001

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Summary: During the previous grant period, we focused on (a) effects of lung distention on fetal lung growth and development and (b) apoptosis in the fetal lung. The current project extends our observation on fetal lung distention and relates them to the clinical problem of congenital diaphragmatic hernia (CDH) and new methods of treating CDH prenatally. Congenital anomalies are a leading cause of neonatal death, with pulmonary hypoplasia the most common anomaly in infants dying the neonatal period. CDH, a major cause of pulmonary hypoplasia, occurs once in 2400 births and has a high mortality rate. Fetal lung growth depends primarily on physical, or mechanical factors, which influence lung growth by changes in lung distension, or stretch, a potent stimulus for diverse cellular effects. With CDH, pulmonary hypoplasia results from alteration of several of these factors. Occluding the fetal trachea distends the lung with fluid and stimulates lung growth, findings that have led to clinical efforts to treat CDH prenatally by tracheal occlusion. Although preliminary results have been encouraging, little is known about effects of tracheal conclusion on some aspect of lung development crucial to adequate pulmonary function, including quantitative lung morphology, the pulmonary vasculature, and lung water balance. Also, tracheal occlusion produces potentially adverse effects, such as decreases in surfactant and alveolar type II cells. Administration of the pesticide of the pesticide, nitrofen, to pregnant rats causes CDH and pulmonary hypoplasia in 60% of the fetuses; the condition resembles CDH in human infants. We propose to distend, by tracheal occlusion, the lungs in fetal rats with nitrofen-induced CDH and to study the effects on lung growth and maturation, on differentiation of the distal pulmonary epithelium, on quantitative pulmonary and vascular morphology. on lung water transport and on components of the cytoskeleton, which is involved in cellular transduction of mechanical stimuli. We will also examine effects on maternal (a) glucocorticoids, which accelerate lung maturation, but which may adversely affect septation and lung growth, and of (b) retinoic acid, which postnatally increases septation and reverses the decreased septation due to dexamethasone. We have shown that apoptosis is a normal process in fetal lung development. How3ever, because changes in lung distension have little effect on apoptosis, further studies of that process are not included in the current project. Results of the proposed studies will increase our knowledge of fetal pulmonary biology and provide new information that may have direct bearing on the clinical problem of CDH. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: ENGINEERED MALFORMATIONS

VASCULAR

TISSUE

FOR

CONGENITAL

Principal Investigator & Institution: Marler, Jennifer J.; Children's Hospital Med Ctr (Cincinnati) 3333 Burnet Ave Cincinnati, Oh 45229 Timing: Fiscal Year 2003; Project Start 26-SEP-2003; Project End 31-AUG-2008 Summary: (provided by applicant): Congenital malformations, such as esophageal atresia, gastroschisis, congenital diaphragmatic hernia, and cutis aplasia remain a leading cause of neonatal morbidity and mortality. Traditional surgical reconstructive approaches have included the use of prosthetic materials, transfer of adjacent healthy tissues, and transplantation from donor individuals. These options are particularly limited in neonates, however, secondary to rapid growth, limited availability of healthy tissue for reconstruction, and lack of age and size-matched donor individuals. Tissue engineering is a multidisciplinary field that combines engineering and the life sciences to create structures, which restore, replace or augment tissues that have been lost secondary to congenital deficiency, disease, or trauma. The most common methodology combines bioresorbable polymer scaffolds and autologous cells that have been

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expanded in tissue culture to form new tissues. This approach holds particular promise for generating surgical replacement structures for reconstruction of several congenital malformations. There have been significant advances in engineering avascular tissues, such as cartilage. There has also been some success in generating, "thin" tissues, such as cardiac leaflets and cultured skin substitutes. When tissues less than 2mm in thickness are transplanted, their metabolic requirements are supported initially through diffusion and later by the ingrowth of new blood vessels from adjacent structures. Thicker tissues, however, cannot rely initially on diffusion and are unable to survive the period required for vascular ingrowth. Thus, one strategy to engineer thicker tissues is to incorporate a blood supply de novo - assembling a microvasculature in tissue culture prior to implantation, allowing other cell types to grow around it, and then connecting this with existing vessels using microsurgical techniques. The principal objective of this project is to create a three-dimensional, branching, functional microvascular network in vitro which will provide a structural and metabolic framework to permit the engineering of thicker vascularized tissues for surgical reconstruction. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: EPIDEMIOLOGIC AND BIOLOGIC PREDICTORS OF IVF SUCCESS Principal Investigator & Institution: Cramer, Daniel W.; Professor; Brigham and Women's Hospital 75 Francis Street Boston, Ma 02115 Timing: Fiscal Year 2001; Project Start 01-AUG-1994; Project End 31-JUL-2003 Summary: In 1994, more than 39,000 cycles involving ART were performed in the United States. Given the cost of approximately 8,000 per cycle, studies are needed which could improve the likelihood that ART will result in a successful pregnancy. In 1994, the investigators initiated a study of couples seeking ART that involved collect of baseline epidemiologic data, treatment variables, and biological specimens. The preliminary data collected on 927 couples, support published findings and suggest exciting new ones. Only 8 percent of women over the age of 39 years became pregnant other first ART cycle and the number of eggs retrieved during ART decline more rapidly after the age of 33 years. Key exposure examined in men and women included caffeine, alcohol, and tobacco. In women, smoking was the principal exposure that decreased number of eggs retrieved. The decrease occurred in both current and former smokers. In men, caffeine use decreased ART success. This association was not present if the ART cycle involved direct injection of sperm in eggs which suggests that caffeine (or tannins in coffee or tea) could be affecting ART success (or natural fertility) by interfering with sperm-egg penetration. Women with the primary diagnosis of endometriosis had fewer eggs retrieved, whereas diagnosis of hernia or varicocele was linked to decreased sperm concentration. Use of a gonadotropin releasing hormone agonist in a long or down regulation fashion prior to ovarian stimulation was associated with markedly better ART success and egg retrieval than used in the short or flare regimen. The joint effect of these female, male and treatment variables will be examined in discrete failure application, the investigators propose continuation of the study, anticipating that in increase in the sample size of 3,000 would allow them to examine important associations in diagnostic or treatment subgroups, as well as expand the power to study other intriguing preliminary findings. These include an association between endometriosis and a polymorphic variant, known as N314D, a key gene in galactose metabolism; evidence that acetaminophen use may lower follicle stimulating hormone levels; and evidence that alcohol use in men adversely affect sperm morphology. The investigators' ability to study male factor infertility will be enhanced by collection of a blood specimen from men and retrieval of residual semen after ART. The continued goal is to assess the

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effect of epidemiologic and biologic markers and treatment-related variables of ART success and to address broader aspects of reproductive physiology by examining gamete number and quality as outcomes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: FETAL MRI & ULTRASOUND DIAPHRAGMATIC HERNIA IN FETUSES

FOR

CONGENITAL

Principal Investigator & Institution: Harrison, Michael R.; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 94122 Timing: Fiscal Year 2001; Project Start 01-DEC-2000; Project End 31-MAR-2002 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: FETAL TRACHEAL OCCLUSION FOR SEVERE DIAPHAGMATIC HERNIA Principal Investigator & Institution: Farmer, Diana L.; Surgery; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 94122 Timing: Fiscal Year 2001; Project Start 01-APR-1999; Project End 31-OCT-2003 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: GENE MUTATION AND RESCUE IN HUMAN DIAPHRAGMATIC HERNIA Principal Investigator & Institution: Donahoe, Patricia K.; Marshall K. Bartlett Professor of Surger; Massachusetts General Hospital 55 Fruit St Boston, Ma 02114 Timing: Fiscal Year 2001; Project Start 05-JUL-2001; Project End 31-MAR-2006 Summary: The lung hypoplasia associated with congenital diaphragmatic hernia (CDH) is largely responsible for the high mortality of the common congenital malformation. The fact that CDH can be diagnosed in utero at mid-trimester means that improvement prior to birth may be possible if we can determine the molecular etiology or understand the critical pathways responsible for the malformation. We will use previously collected and prospective CDH and normal fetal lungs to study the expression of genes known to be associated with human CDH or mouse knockouts which have CDH phenotypes (Aim II). Similar we will study candidates that arise from Drosophila, chick, or rodent screens, then determine if complementation can correct phenotypes of CDH in these models (Aim II). As the next step we will clone human homologous and design human probes from the coding regions of the most promising candidates for mutational scanning of CDH patients and their families (Aim III). A database will be established for all CDH patients who came to the MGH for prospective care by our Pediatric Surgical Service, and their families, as well as for all of those patients cared for by the Pediatric Surgical Service since 1970 (Aim 1). These patients and families will provide blood and tissue from which cell lines will be immortalized for chromosomal and genetic analysis. Loss of homozygosity scanning will be done for 15q22-ter, 12q, and 8q regions (Aim IV) and candidate genes revealed by the scans will be tested for expression in the discarded fetal normal and CDH lungs and for complementation of CDH phenotype in the animal model. Genes which are abnormal in CDH patients can be complemented in the various small animal models will be used to design treatment strategies for humans with CDH after appropriate testing in larger animal models.

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Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: GENETIC APPROACHES TO DISCOVER NEW TREATMENTS FOR CDH Principal Investigator & Institution: Kawaguchi, Akemi L.; Massachusetts General Hospital 55 Fruit St Boston, Ma 02114 Timing: Fiscal Year 2003; Project Start 01-APR-2003; Project End 31-MAR-2005 Summary: (provided by applicant): Congenital diaphragmatic hernia (CDH) remains a difficult clinical problem with a mortality rate of nearly fifty percent. In CDH, the abdominal contents may herniate into the thoracic cavity, resulting in poor pulmonary development with resulting pulmonary hypoplasia. Even when the compression is reduced early in gestation, the lungs remain hypoplastic, suggesting a genetic component of the defect. Early lung development is remarkably conserved between humans and avian species. Therefore, a chick model was chosen for series of experiments designed to describe the function of four candidate factors- FT68, FT137, FT347, and FT399. These factors were described in our laboratory, and have been shown to be expressed in normal chick lung development. We will first study the temporal and spatial expression of these factors using in situ hybridization. Next, we will perform targeted lung infection with avian-specific retrovirus constructed with full-length, wild type candidate cDNA for overexpression and misexpression studies. The lungs will be analyzed at various developmental stages for gross morphology, histology, cytodifferention, and expression of known factors important in pulmonary development. If these factors are found to play a significant role in chick pulmonary development, the expression of human orthologs will be studied further with a library of archived normal and abnormal fetal and neonatal human lung samples. We hope that by better understanding the molecular events of normal and abnormal lung development, we will better understand pulmonary hypoplasia and to develop novel pharmacologic therapies for CDH. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: HINDBRAIN MYELOMENINGOCELE

HERNIATION

IN

SHEEP

MODEL

OF

Principal Investigator & Institution: Von Koch, Cornelia S.; Neurological Surgery; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 94122 Timing: Fiscal Year 2002; Project Start 15-JUL-2002; Project End 22-JUN-2003 Summary: (provided by applicant): Myelomeningocele (MMC), seen in 0.5-1 per 1000 live births, is almost always associated with hindbrain herniation or Chiari II malformation, and represents one of the most debilitating birth defects in humans. Hindbrain herniation results in impaired brainstem and cranial nerve function. Abnormal cerebral spinal fluid flow results in syrinx formation and hydrocephalus. Therefore, patients present with respiratory depression, apneic spells, lower cranial nerve palsies, and quadriparesis. Hydrocephalus develops in 83-90% of patients and almost always requires shunting. Shunt malfunction and infection represent the most common late mortality in MMC patients. We propose to prevent hindbrain herniation and hydrocephalus formation in sheep via in utero repair of surgically created MMC. Fetal lambs will undergo MMC creation at mid-gestation and half will be repaired in utero at 2/3 of gestation. At birth, lambs with in utero MMC repair should be free of hindbrain herniation and not develop hydrocephalus, in comparison with lambs without in utero MMC repair. If this holds true, in utero repair in humans may prevent

20 Hernia

the devastating consequences of hindbrain herniation and hydrocephalus. Furthermore, we will characterize in lambs gross pathological and axonal pathfinding anomalies usually seen in the human disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: INGUINAL HERNIA MGMENT: WATCHFUL WAITING VS. OPERATION Principal Investigator & Institution: Fitzgibbons, Robert J.; Professor of Surgery; American College of Surgeons 633 N St. Clair St Chicago, Il 60611 Timing: Fiscal Year 2001; Project Start 30-SEP-1999; Project End 29-SEP-2004 Summary: Inguinal hernia is one of the most common worldwide afflictions of men. Because the presence of an inguinal hernia is usually considered an indication for its repair, little is known about the natural history of this abnormality in minimally symptomatic patients. Approximately 700,000 herniorrhaphies are performed in the U.S. each year, with large direct costs of surgical care and indirect costs to the economy resulting from time-off from work, school, or usual activities. The indications for surgical repair of a minimally symptomatic hernia are vague, and it is not known whether patients with inguinal hernias can safely delay surgical treatment and if they will accept Watchful Waiting (WW) as the method of management for their hernia. This multicenter collaborative project between the American College of Surgeons, Northwestern University, and the VA Cooperative Studies Program, proposes to enroll 753 men with asymptomatic or minimally symptomatic inguinal hernias, either primary or-recurrent. Patients will be recruited at 5 community and academic sites over a 2.5 year period with follow-up for a minimum of two years and an average of 3.25 years. WW will be compared with tension-free open repair (TFH). Primary outcome measurements will be: (1) Pain or discomfort limiting usual activities; (2) Changes in the Physical Component Summary score of the SF-36. Secondary outcome comparisons include cost, complications (including hernia accident and recurrence), satisfaction, and the incidence of any hernia-related operation. The role of age and comorbidity and their interactions in influencing the patient-centered outcome of hernia management will be determined. This trial will substantially increase knowledge of the natural history of inguinal hernia in men, provide useful information on medical, patient-centered, and cost outcomes of the various treatment options, and guide selection of the appropriate treatment of this common surgical disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: LASER-ACTIVATED HERNIORRHAPHY

COLLAGEN

ADHESIVES

FOR

Principal Investigator & Institution: Soltz, Barbara A.; Conversion Energy Enterprises 81 Pine Brook Rd Spring Valley, Ny 10977 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-JUL-2003 Summary: (provided by applicant): Approximately 1 million inguinal herniorrhaphies are performed annually in the US. Laparoscopic approaches have been developed but clinical acceptance has been hampered by problems such as stability of the mesh fixation, inadequate peritoneal closure, adhesion formation and the probability of internal herniae development. Laser assisted tissue welding using a derivatized collagen solder for tissue/mesh attachment may avoid compression or tissue injury which frequently occurs with mechanical fixation and may offer the additional benefit of minimizing postoperative pain due to tissue ischemia and nerve entrapment

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syndromes. This study will investigate laser-activated collagen solders for mesh attachment and closure. Laser operating parameters will be optimized to promote strong solder crosslinks to gastrointestinal tissue. An integrated temperature feedback controller will be used to prevent peripheral tissue damage. The proposed study includes the accurate measurement of previously unknown values for inherent solder strength, repair strength and type of failure mode. A surgical handpiece will be modified for use in animal experiments. By comparing a conventional method for mesh fixation to laser attachment, weld integrity, tissue healing and inflammatory response will be defined. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: LUNG DEVELOPMENT IN CONGENITAL DIAPHRAGMATIC HERNIA Principal Investigator & Institution: Larson, Janet E.; Ochsner Clinic Foundation 1514 Jefferson Hwy New Orleans, La 70121 Timing: Fiscal Year 2003; Project Start 01-JUL-2003; Project End 30-JUN-2005 Summary: (provided by applicant): Congenital diaphragmatic hernia (CDH) is associated with the structural abnormality of pulmonary hypoplasia. These changes are mimicked in the rodent model of nitrofen-induced CDH. Nitrofen (2,4-dichlorophenylp-nitrophenyl ether) is an herbicide that when fed to a pregnant rodent at day 9 or 10 creates diaphragmatic hernia and/or lung hypoplasia in the fetuses. When treated with nitrofen the fetuses demonstrate epithelial cell immaturity as well as hypoplasia. In contrast, the investigators have found that in utero gene therapy with CFTR (the gene responsible for Cystic Fibrosis) results in epithelial cell hyperplasia and accelerated epithelial cell differentiation. The investigators hypothesize that in utero gene therapy with cftr will reduce the pulmonary hypoplasia and epithelial cell immaturity associated with CDH. This hypothesis can be tested in the fetal rat by treatment with nitrofen at 910 days gestation followed by in utero gene therapy at 16-17 days gestation. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CLEARANCE

MECHANISM

OF

GASTROESOPHAGEAL

REFLUX

AND

Principal Investigator & Institution: Massey, Benson T.; Medical College of Wisconsin Po Box26509 Milwaukee, Wi 532264801 Timing: Fiscal Year 2002 Summary: The gastroesophageal junction is the first portal through which noxious gastric contents must pass if they are to cause injury to the upper aerodigestive tract. When reflux occurs excessively and clearance of reflux is impaired, patients can develop esophagitis, ulcers, stricture, adenocarcinoma, laryngitis, and aspiration pneumonia. Unfortunately, the mechanisms for initiating and suppressing reflux and the factors contributing to the altered clearance of the refluxate are poorly understood. The specific objectives of this subproject are to explore the following hypotheses: 1). Intragastric pressure is a major determination of whether reflux occurs, with reflux patients having lower threshold pressures for triggering reflux. 2). Afferent sensory pathways in the cardia of the stomach are important in triggering GERD. Agents can be delivered endoscopically to block these pathways and inhibit GER. 3). Esophageal longitudinal muscles play an active role in the reflux event. 4). Esophageal acidification alters the function of longitudinal esophageal muscles, so as to contribute to forming a hiatal hernia. 5). Longitudinal esophageal muscle function during primary and secondary

22 Hernia

peristalsis is abnormal in patients with reflux disease, and these abnormalities contribute to disturbances in esophageal bolus clearance. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: MOLECULAR CONTROL OF PATTERN FORMATION IN THE CHICK LUNG Principal Investigator & Institution: Roberts, Drucilla J.; Massachusetts General Hospital 55 Fruit St Boston, Ma 02114 Timing: Fiscal Year 2001; Project Start 05-JUL-2001; Project End 31-MAR-2006 Summary: Pulmonary malformations are common human congenital anomalies that carry a high morbidity and mortality rate. Pulmonary hypoplasia (PHP), a lung growth and patterning anomaly, accounts for the majority of neonatal mortality in otherwise salvageable cases of congenital diaphragmatic hernia. There is very little known about the molecular aspects of PHP. In this program project we exploit the fact that molecules responsible for normal lung development are conserved across animal species from fly to man and hypothesize that alterations in their function or express pattern cause PHP. Our goal is to identify which pattern the lung and may be mutated, absent or misexpressed in human PHP to find novel treatments, prevention or early diagnosis. We propose to identify and characterize these factors in three different model systems: Drosophila, chick, and rodent- and translate our findings to humans using or archives of normal and abnormal human fetal lungs and families with an affected PHP member. In Project I (herein), the avian retroviral expression system will be used to identify factors necessary for normal lung development by analysis of candidate factors in their developmental expression patterns and function by mis-, over-, and mutated expression in the chick embryonic lung in ovo. Project 1 has three specific aims: (1) Analyze the expression pattern of candidate factors in normal lung development in the chick. Candidate factors include those from the published literature implicated as candidates by their expression pattern in the developing lung or by mutations resulting in a pulmonary phenotype: secreted factors (Shh, Bmp4, Fgf10), transcription factors (Hoxa5, Hoxb5, Sox2, Nkx2.1, Gli2, Gli3), and receptors (Fgf42IIIb). In preliminary data we present new factors identified in a chick lung bud screen (1 novel factor, 2 transmembrane receptors, 1 transcription factor) we will test for developmental pulmonary expression. Additionally, we factors to be identified in the Drosophila screen (Project II) will be cloned in the chick and studied for pulmonary developmental expression. Only those candidates with spatial and/or temporally restricted expression in the developing lung will be studied in Specific Aim 2. (2) Analyze the function of candidates in chick pulmonary development. Avian specific retroviral constructs made from wild-type full-length candidate cDNAs as well as directed mutated forms will be used to mis- and/or over-express these factors in the developing avian lung in ovo. Only those factors which can phenocopy PHP in these experiments will be studied in Specific Aim 3. (3) Identify which factors are expressed in human lungs and if they are altered in expression in hypoplastic lungs. Fetal and pediatric normal and abnormal lungs are available from an archived tissue bank and will be collected prospectively. Human homologs will be obtained or cloned to analyze their expression in these tissues. Those candidates that are deemed strong will be analyzed for expression (as well as function and rescue) in rodent models of pulmonary hypoplasia (Project III) and a genetic analysis of PHP families in Project IV. We expect to identify factors which when mutated or aberrantly expressed result in PHP. This information may provide novel treatment regimes and early diagnosis making early intervention possible. We hope to

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increase the survival rates of infants with isolated congenital diaphragmatic hernia and PHP. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: NEONATAL INHALED NITRIC OXIDE Principal Investigator & Institution: Ehrenkranz, Richard A.; Yale University 47 College Street, Suite 203 New Haven, Ct 065208047 Timing: Fiscal Year 2001 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: NEW BIOMATERIALS TO MINIMIZE SCAR TISSUE FORMATION Principal Investigator & Institution: Sanders, Joan E.; Bioengineering; University of Washington Seattle, Wa 98195

Associate

Professor;

Timing: Fiscal Year 2001; Project Start 15-MAR-2000; Project End 28-FEB-2003 Summary: (verbatim from the proposal): Fibrous encapsulation is an important limitation of current biomaterials intended for integration with soft collagenous tissues (e.g. abdominal wall repair, hernia repair, skin replacement from burn or ulceration, intestinal ulcer repair). A fibrous capsule can wall off the device, produce scar tissue that can adhere to underlying structures, and isolate the material from mechanical or chemical integration. However, preliminary implantation data suggest that if polymer fibers that make up the implant are very small, on the order of collagen fiber dimensions in the soft tissues (0.5-3.0 mm diameter), then fibrous encapsulation is minimized or eliminated. This feature, if validated in a systematic scientific manner, could be utilized in fibro-porous biomaterial design to create more effective devices. A systematic evaluation of a design feature's influence on bio-response (e.g. fiber diameter effect on healing) will be most useful to the biomaterials design community if it is simultaneously compared with a characteristic that has been well-studied. Biomaterial surface chemistry is the feature of interest selected for comparison here. The purpose of this research is to systematically evaluate the influence of material architecture and surface chemistry on in vivo response to fibro-porous materials. The specific aspect of surface chemistry to be evaluated is surface (ionic) electrical charge. The research proceeds in two stages: analysis on single fibers, and analysis on multi-fiber (fibro-porous) meshes. This twostage approach helps to isolate effects of the different features of interest. Because no traditional biomaterials fabrication method exists for making very small diameter fibers, a technology used mainly in non-biomedical industries called electrospinning is pursued and applied. An in vivo model is used to evaluate fibrous capsule thickness as well as foreign body giant cell density and macrophase cell density in tissue adjacent to the micro-fibers. These are key indicators of implant integration or activation of the foreign body reaction. The significance of this research is to apply an innovative material and fabrication method to assess the influence of specific biomaterial architectural and chemical features of a biomaterial to the tissue response. The approach could lead to a new materials fabrication technology to treat a number of soft-tissue complication in which scar tissue formation is an important clinical problem. The health relatedness of this project is to improve the health and function of persons with soft tissue defects, particularly abdominal wall perforation, intestinal ulceration, abdominal herniation, burns and skin ulceration, i.e. soft-tissue complications that require surgical repair through use of a biomaterial. The new materials will prevent scar tissue formation and reduce the occurrence of secondary complications.

24 Hernia

Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: PHOSPHOCREATINE RECOVERY IN WOMEN W/ CHRONIC FATIGUE SYNDROME Principal Investigator & Institution: Mccully, Kevin; University of Pennsylvania 3451 Walnut Street Philadelphia, Pa 19104 Timing: Fiscal Year 2001 Summary: In Utero surgical techniques for the reversal of anatomical malformations are developed in small mammalian models. The design of new techniques suffers from lack of non-invasive pre- and post-surgical fetal monitoring. We have applied high resolution MRI to in-vivo, in-utero imaging of a rat model for Congenital Diaphragmatic Hernia (CDH). CDH is a developmental anomaly which involves incomplete closure of the diaphragm, herniation of the liver and abdominal viscera into the thoracic cavity, and lung hypoplasia. Eight dams were imaged on days 19-22 of gestation (once a day) to diagnose the presence or absence of CDH and monitor the effects of surgery. Those who were shown to be CDH+ on day 19 underwent immediate surgical tracheal ligation to reverse pulmonary hypoplasia and force the abdominal contents from the thoracic cavity. 39 rat fetuses were imaged using a multislice, T2 weighted, fast spin echo sequence on a 4T whole body imaging system (GE, Signa). Pathology and results of surgery were confirmed post-mortem by high resolution imaging (9.4T) and subsequent microscopic dissection. This information will help in the use and development of in utero intervention for treatment of congenital abnormalities. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PROSPECTIVE CLINICAL STUDIES IN NEONATAL SURGERY Principal Investigator & Institution: Blakely, Martin L.; Surgery; University of Texas Hlth Sci Ctr Houston Box 20036 Houston, Tx 77225 Timing: Fiscal Year 2001; Project Start 01-MAY-2001; Project End 30-APR-2006 Summary: (Adapted from applicant's description): The purpose of the career development activities described in this proposal is for Dr. Martin Blakely, a pediatric surgeon, to acquire the knowledge and skills required to conduct patient-oriented research of the highest quality. The candidate has a proven history of commitment to research during his surgical training. The institutional environment at UT Houston offers extensive resources available to the candidate, e.g. the Clinical Research Curriculum and Mentorship Program funded by an NIH K30 award and directed by the candidate's mentor. The career development plan includes formal mentorship, extensive coursework leading to a Master's of Science degree in clinical research, and participation in the NICHD Neonatal Research Network. Jon Tyson, M.D., M.P.H., is a renowned neonatologist and epidemiologist with extensive experience in clinical research study design and will serve as Dr. Blakely's primary mentor. Dr. Tyson also directs the Center for Population Health and Evidence-Based Medicine whose faculty members are available to the candidate. Kevin Lally, M.D., is a pediatric surgeon with experience in multi-center studies in this field and is the candidate's second mentor. Dr. Lally has established collaborative relationships with pediatric surgeons throughout the US that will facilitate the studies proposed by Dr. Blakely. There are four phases of the research plan. Initially, a series of systematic reviews of therapy for extremely low birthweight (ELBW) infants with necrotizing enterocolitis (NEC) will be completed and published in the Cochrane Library. Secondly, a multi- center prospective observational study documenting center variability and patient outcome after surgery for NEC in ELBW

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infants will be performed. The proposal for this study is under review by the NICHD Neonatal Research Network, of which Dr. Tyson is a principal investigator. A primary purpose of this study is to document the need for and to help design a randomized clinical trial described below. The third phase consists of completing an on-going randomized clinical trial comparing early versus late inguinal hernia repair in premature infants. And lastly, based on the results of the observational NEC study, it is anticipated that a randomized trial will be designed near the end of the award period to compare simple peritoneal drainage versus formal laparotomy in infants with NEC, which is a very controversial question in neonatal surgery. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: REGULATORS OF FETAL RODENT PULMONARY HYPOPLASIA Principal Investigator & Institution: Schnitzer, Jay J.; Associate Visiting Surgeon; Massachusetts General Hospital 55 Fruit St Boston, Ma 02114 Timing: Fiscal Year 2001; Project Start 05-JUL-2001; Project End 31-MAR-2006 Summary: Infants with congenital diaphragmatic hernia (CDH) die from inadequate lung function, which is a combination of 1) pulmonary hypertension of the newborn. The pulmonary hypoplasia is characterized by immature, small lungs. We have demonstrated the efficacy of prenatal glucocorticoid therapy in accelerating pulmonary maturation in CDH lung in fetal rats and sheep. We have further shown that prenatally administered antioxidants , particularly vitamin E, accelerate prenatal growth of CDHassociated hypoplastic lungs in vitro and in vivo. We have demonstrated significant differences in the levels of mitogen- activated protein (MAP) kinase phosphorylation (extracellular signal regulated protein kinases, ERK-1 and -2) between CDH and normal fetal lungs, and have shown increased phosphorylation towards that observed normally, in CDH lungs after treatment with vitamin E in vivo. We hypothesize that important regulators and pathways of normal and hypoplastic fetal lung growth converge on the mitogen-activated protein (MAP) kinase pathways. We further hypothesize that antioxidants stimulate hypoplastic fetal lung growth via the MAP kinase cascade, and, in particular, via up-regulation of the MAP kinase kinases (MEK +) and Raf-1. We propose to define the molecular mechanism(s) in the rodent responsible for the salutary effects of the anti-oxidants and define the modulators of signal transduction pathways responsible for CDH- associated pulmonary hypoplasia. We will reestablish that the observed stimulation of embryonic lung growth by antioxidants occurs via a reductant mechanism and determine where antioxidants impact the MAP kinase pathways. We will establish the role of other candidate genes and pathways in fetal lung hypoplasia, define whether differences exist in gene expression patterns in the various rodent CDH models, and study in the rodent model worthy candidate genes identified in Projects I, II, and IV. We hope that these studies will provide new insights into the mechanisms of prenatal lung growth control. These, in turn, can provide a platform for the future development of prenatal targeted therapies. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: DROSOPHILA

REGULATORS

OF

TRACHEAL

MORPHOGENESIS

IN

Principal Investigator & Institution: Perkins, Lizabeth A.; Associate Professor; Massachusetts General Hospital 55 Fruit St Boston, Ma 02114 Timing: Fiscal Year 2001; Project Start 05-JUL-2001; Project End 31-MAR-2006

26 Hernia

Summary: All multi-cellular animals must transport fluids and gases to an from all cells of the body. In many instances this process is achieved by branching tubular organs with lumen by epithelial cells. In vertebrates, organs composed of branching tubes include the vasculature system, lungs, pancreas, and kidney. In vertebrates, the tracheal system of Drosophila is a branching tubular organ conserved at the molecular level; e.g., both require the reiterative use of an FGF receptor tyrosine kinase (RTK) signaling pathway. A unique environment within the Massachusetts General Hospital is providing an opportunity to elucidate pulmonary development from flies to humans. The identification of genetic analyses of conserved molecules that function during normal tracheal development in flies will guide the analyses of these same molecules during mammalian lung development. These integrated, comparative studies, therapies and/or therapeutics that will positively impact the treatment of the pulmonary hypoplasia associated with the common and tragic malformation Congenital Diaphragmatic Hernia. Project 2. Regulators of Tracheal Morphogenesis to Drosophila Using Drosophila as a model system, a genome wide screen has identified regions encoding genes that modify the function of Csw, a tyrosine phosphatase that transduces RTK signals, including those required for tracheal morphogenesis. Six regions that enhance and 14 that suppress Csw function encode genes not presently identified as components of RTK signaling. The goal of Aim 1 is to identify which regions alter tracheal development, and then to isolate and characterize selected modifiers of tracheal development. Building upon findings from chick and mouse animal models (Project 1 and 4), as well as genomic and chromosomal analyses derived from the study of patients with CDH (Project 4) the goal of Aim 2 is to analyze conserved genes functioning during tracheal morphogenesis. We will determine if Drosophila homologues of genes expressed during lung morphogenesis are conserved in flies. If so, we will genetically characterize selected Drosophila homologues to elucidate their functions during tracheal development. The goal of Aim 3 is to establish Drosophila as a model genetic system to search for new, or analyze existing pulmonary therapeutics. As in vertebrates, tracheal morphogenesis in flies is modified by the molecular environment. Drosophila will be used to screen existing "lung maturing" therapeutics, antioxidants, and selected drugs (Project 3) for their effects on the developing tracheal system. As the first step toward an ultimate goal to develop new lung maturing therapies, we will modify the environment with these compounds to create a "sensitized background" from which to screen for genes whose functions are modified by the compound. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: SCOR IN PATHOBIOLOGY OF LUNG DEVELOPMENT Principal Investigator & Institution: Stenmark, Kurt R.; Professor of Pediatrics; Medicine; University of Colorado Hlth Sciences Ctr P.O. Box 6508, Grants and Contracts Aurora, Co 800450508 Timing: Fiscal Year 2001; Project Start 01-DEC-1996; Project End 30-NOV-2001 Summary: (Adapted from the Applicant's Abstract) This proposal from the Department, University of Colorado seeks five year funding for a new program to investigate three pulmonary hypertensive disorders of newborns- hyaline membrane disease from premature birth, congenital diaphragmatic hernia, and persistent pulmonary hypertension of the newborn (PPHN). Collectively, these syndromes occur about 1:500 live births despite intensive, invasive and costly treatment. Morbidity and mortality remain high, up to 50% with severe disease. This program seeks to investigate the causes of high resistance to lung blood flow in these syndromes which include: inadequate blood vessel formation, obstruction from thickened arterial walls, and

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27

excessive constriction of the lung arteries. Thus, the key questions to be addressed by the basic research are: 1) how do pulmonary blood vessels form, (2) what factors contribute to vascular wall cell replication and matrix formation and thus vascular thickening, (3) what mechanisms cause high vascular tone in the fetus and sudden relief of that tone at the moment of birth, and (4) how do noxious stimuli damage vessels and their functions both before and after birth? To answer these questions the investigators will examine normal and abnormal pulmonary vascular development in fetuses and newborns in several species. Further, the investigators propose to extend to pulmonary hypertensive infants with hyaline membrane disease and congenital diaphragmatic hernia the clinical management which has been successful in PPHN, and which combines high frequency oscillatory ventilation and small amounts of inhaled nitric oxide with good hospital care. Also, based on animal experiments and encouraging preliminary clinical usage, the investigators will attempt to augment nitric oxide s benefit by administering phosphodiesterase inhibitors to prolong nitric oxides vasodilating effect in all three patient groups. The proposal seeks to improve the well being in new born children through an integrated program of basic research with experiments in whole animals, whole organs, cell cultures using state-of-the-art biochemical and genetic molecular research methods combined with innovative clinical care. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: THE ESOPHAGOGASTRIC JUNCTION IN HEALTH AND DISEASE Principal Investigator & Institution: Kahrilas, Peter J.; Professor of Medicine; Medicine; Northwestern University Office of Sponsored Programs Chicago, Il 60611 Timing: Fiscal Year 2001; Project Start 01-APR-2001; Project End 31-MAR-2006 Summary: (Verbatim from Applicant's Abstract): Gastroesophageal reflux disease (GERD) is a common disorder, affecting millions of Americans and caused by anatomical and physiological perturbations of the esophagogastric junction (EGJ). The economic impact of GERD in the US is evident by the annual expenditure of >$4 billion for pharmaceutical treatments. Although effective, medical therapy is by nature compensatory, as opposed to potentially curative surgery. However, a problem with antireflux surgery has been unpredictable postoperative dysphagia and bloating related to a diminished ability to belch. Thus, this revised RO1 application represents a collaborative effort by a gastroenterologist (Dr Kahrilas), a surgeon (Dr Joehl), and a mechanical engineer (Dr Brasseur) to study perturbations of the EGJ imposed by GERD and by surgical treatments of GERD (Nissen fundoplication). Specific aim #1 addresses antegrade EGJ function while specific aim #2 investigates mechanisms of reflux. Antegrade EGJ function will be quantified with an "esophageal stress test" using manometry with concurrent fluoroscopy while swallowing boluses of defined viscoelastic properties. These data will be complimented by a dysphagia questionnaire. Data from controls will be compared to that of GERD patients and patients after antireflux surgery. The underlying hypothesis of specific aim #1 is that a mathematical model of the EGJ, embedded within a "computer laboratory" and based on the best anatomical and physiological data obtainable will improve understanding and prevention of post-surgical dysphagia. Specific aim #2 is focused aboutextending our investigations into the interplay between anatomical and physiological factors in the pathophysiology of GERD. Investigational methodologies include using a barostat to create measured degrees of gastric distension and to ascertain EGJ compliance during fluoroscopy of the EGJ, using intragastric air insufflation to study the physiology of transient LES relaxations and high resolution manometry to map the geometry and

28 Hernia

mobility of the EGJ. An underlying hypothesis is that the optimal surgical management of a patient with tLESR induced reflux is different than of the patient with a patulous sphincter. The ultimate goal is to tailor the surgical management of GERD for the individual patient based on physiological studies of that patient with the hope that this will improve the efficacy and reduce the complications of antireflux surgery. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: THE HIGH PRESSURE ZONE OF THE DISTAL ESOPHAGUS Principal Investigator & Institution: Miller, Larry S.; Medicine; Temple University 406 Usb, 083-45 Philadelphia, Pa 19122 Timing: Fiscal Year 2001; Project Start 01-JUN-2001; Project End 31-MAY-2004 Summary: (Applicant's Abstract): The PI's hypothesis is that the crural diaphragm interacts with the intrinsic lower esophageal sphincter in a very complex manner. These interactions take two forms: 1) space-time interactions in which the crural diaphragm and intrinsic lower esophageal sphincter (LES) are displaced from each other both in space and in time; and 2) mechanical interactions in which each component of the LES and CD contributes to the pressure generated at the gastroesophageal junction highpressure zone (GEJHPZ) individually and in combination. When there are abnormalities in either of these interactions, at the GEJHPZ reflux events and retrograde flow of fluids will occur. The purpose of this proposal is to determine the relative physiologic roles of the intrinsic LES and CD in providing an anti-reflux barrier at the GEJHPZ. The PI plans to define the relative motion of the CD to the intrinsic LES the relaxation and contraction of the CD in relationship to the LES, the compressive effect and forces of the CD on the distal esophagus, the role of the CD in antegrade movement of liquids and the role of the CD in induced relaxation of the GEJHPZ and retrograde movement of liquids from the stomach to the esophagus. Simultaneous high-resolution ultrasound and manometry will be utilized to correlate anatomical position (structure) with pressure (function). To achieve these specific aims the PI plans to: 1) determine the effect of respiration on the position and pressure relationships of the intrinsic LES and CD as components of the GEJHPZ. The investigators hypothesize that respiration causes movement of the crural diaphragm relative to the intrinsic LES and, therefore, effects the anatomical relationship of these two structures to each other; 2) separate the intrinsic LES from the crural diaphragm using physiologic and pharmacologic manipulations. The manometric contribution of the CD to the GEJHPZ will be determined by using pharmacologic and physiologic maneuvers to strengthen, diminish and even ablate the effects of the CD in order to better define the contribution of the CD to the GEJHPZ: 3) determine the effect of esophageal shortening during swallowing on the antireflux barrier GEJHPZ. This will be done by quantitating, the relative displacement of the intrinsic LES and CD to each other, in response to esophageal shortening, during swallowing of various bolus volumes of water; and 4) utilize several conditions in which the CEJHPZ structure and function are distorted to study the relative roles of the LES and CD. These conditions include hiatal hernia (displacement of the LES); Nissen fundoplication (reinforced HPZ) prior resection of the gastroesophageal junction (loss of the intrinsic LES); and GERD with and without hypotensive LES. Aim 5 Study the effect of retrograde flow at the GEJHPZ by inducing relaxation of the GEJHPZ and eliciting reflux events. This will be achieved by distending the fluid filled stomach with an air filled balloon, or distending the esophagus with an air filled balloon to induce relaxation of the GEJHPZ and elicit retrograde fluid movement from the stomach to the esophagus in normal controls and patients with GERD with and without a hypotensive LES. They will delineate both the

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normal and abnormal interactions of the LES and CD, using simultaneous ultrasound and manometry to define the physiology and pathophysiology of the GEJHPZ. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: TISSUE RECONSTRUCTION

ENGINEERING

FOR

DIAPHRAGMATIC

Principal Investigator & Institution: Krupnick, Alexander S.; Surgery; University of Pennsylvania 3451 Walnut Street Philadelphia, Pa 19104 Timing: Fiscal Year 2001; Project Start 15-JUL-2001 Summary: Congenital diaphragmatic hernia (CDH) is one of the most devastating anomalies afflicting the neonate. Visceral herniation associated with CDH results in fetal pulmonary hypoplasia often incompatible with life. Despite the previously dismal prognosis of babies with CDH, new technologies such as extracorporial membrane oxygenation, high frequency jet ventilation, and nitric oxide have extended survival past the peri-natal period. Fetal tracheal occlusion has provided a novel method to promote lung growth and potentially reverse pulmonary hypoplasia. Conclusive repair of the actual diaphragmatic defect responsible for the pathophysiology of CDH, however, still remains unsolved. Although a minority of diaphragmatic defects can be closed primarily, patch closure with polytetrafluoroethylene (PTFE) remains the standard of care. Despite its adequacy for closing the defect, long-term problems such as foreign body infection, recurrent herniation, and adhesions remain a problem with PTFE. The objective of this study is to utilize the principles of tissue engineering in order to develop a neodiaphragm for repair of congenital diaphragmatic hernia. Tissue harvested for the creation of the neodiaphragm will come from the same animal at an earlier point in its development, avoiding the problem of graft rejection. First, neonatal rat myoblasts and fibroblasts will be harvested and established in tissue culture. Next, a biodegradable polyglycolic acid matrix will be seeded with the expanded myoblasts and fibroblasts. Finally, a diaphragmatic defect will be created in a rat and immediately repaired with the biodegradable construct. We hypothesize that with the degradation and breakdown of the polyglycolic acid matrix the myoblasts and fibroblasts attached to the matrix will organize into a myofascial sheet recapitulating the original diaphragm. Similar methods have already been used in clinical practice to replace bladder and skin defects in the neonate. We hope to ultimately apply these methods toward diaphragmatic repair in human clinical trials. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: TISSUE DEVELOPMENT

INTERACTIONS

IN

PULMONARY

VASCULAR

Principal Investigator & Institution: Shannon, j; University of Colorado Hlth Sciences Ctr P.O. Box 6508, Grants and Contracts Aurora, Co 800450508 Timing: Fiscal Year 2001 Summary: (Adapted from the applicant's abstract) Pulmonary hypertension is a significant clinical problem in the neonate that is required to three structural abnormalities: maladaptation, maldevelopment, and pulmonary hypoplasia. They hypoplastic lung is characterized by decreases in vascular development that parallels those seen in the underdeveloped epithelium. While the advent of nitric oxide (NO) treatment has resulted in improved outcomes for patients with maladaptation and maldevelopment, patients with pulmonary hypoplasia are refractory to NO treatment and have the worst prognosis. Much effort has been expanded in elucidating the factors

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that regulate lung growth, but most of these studies have focused on the development of the lung epithelium and its production of pulmonary surfactant. A consistent observation has been that epithelial development is absolutely dependent on an interaction with pulmonary mesenchyme. In contrast, surprisingly little is known about the molecular regulation of the lung vasculature, especially during the earliest periods of development. The underlying hypothesis of this proposal is that the proliferation and differentiation of endothelial cells in the developing lung are dependent on an interaction with the epithelium. In this proposal they will first detail pulmonary vascular development in vivo. They will determine when vasculogenesis begins, and how it proceeds over the course of gestation; these results will be correlated with those obtained for human samples. Using several culture systems, they will then directly test their development, both in the early- and late-gestation lung, and determine how this process is affected by a number of hormone growth factors, and cytokines. Vascular endothelial growth factor (VEGF) is likely to play a role in normal vascular development in the lung. They will detail the temporal and spatial pattern of express of VEGF, and determine how this is regulated in vitro. They will then determine the importance of VEGF expression to normal vascular development. They will use molecular techniques to genetically manipulate an increase or decrease in VEGF expression, as well as compromise the ability of one VEGF receptor molecule to function. In the final portion of this project they will apply all of what they have learned to a rat model of congenital diaphragmatic hernia (CDH) that results in significant pulmonary hypoplasia. They will assess in this model whether the observed hypoplasia results from an inherent defect in the lung, or is necessarily secondary to CDH. These results will be correlated with observations will make in hypoplastic lung samples from human infants with CDH. At the completion of this project they expect to have substantially increased our knowledge of the molecular regulation of pulmonary vasculature development. This knowledge will undoubtedly prove useful in the prevention and treatment of diseases resulting from fetal lung immaturity and hypoplasia. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: VEGF REGULATION OF PULMONARY VASCULAR DEVELOPMENT Principal Investigator & Institution: Akeson, Ann L.; Children's Hospital Med Ctr (Cincinnati) 3333 Burnet Ave Cincinnati, Oh 45229 Timing: Fiscal Year 2003; Project Start 01-JUL-2003; Project End 30-JUN-2007 Summary: (provided by applicant): VEGF is a critical component of the highly integrated, multidirectional signaling that orchestrates lung development. Disruption of this coordinated deveIopment is reflected in neonatal lung disease with aberrant VEGF expression including congenital diaphragmatic hernia and bronchopulmonary dysplasia. VEGF activity is regulated by generation of multiple isoforms, each with unique biological properties. The temporal and spatial expression patterns suggest that each VEGF-A isoform provides distinct positional and differentiation cues required for lung vascular development. In this proposal, we will test the hypothesis that each VEGF-A isoform regulates distinct endothelial functions required for progressive pulmonary vascular specification through differential accessibility and binding to VEGF receptors, VEGFR1 and VEGFR2. We propose that early in lung development the diffusible isoforms VEGF-A120 and VEGF-AI64 induce different signal pathways that activate distinct angioblast and endothelial responses. Further, midway through lung development, the heparin-bound isoform, VEGF-A188, expressed by distal epithelial cells generates a morphogenic gradient that induces endothelial migration and alveolarcapillary alignment. Finally, we propose that during the saccular and alveolar stages,

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VEGF-A164 and VEGF-A188 drive endothelial specification required for microvascular development, distal airway development and formation of the air blood barrier. We will use in vitro model systems to analyze the mechanisms of cellular activation by examining isoform-specific receptor activation and associated kinase signaling pathways. Newly developed transgenic models with conditional, lung-specific expression of VEGF-A and dominant-negative soluble receptor will be used to determine the requirements for VEGF-A at each stage of development. Completion of this project will increase understanding of the mechanism of VEGF action and expand knowledge of pulmonary vascular development. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, and type “hernia” (or synonyms) into the search box. This search gives you access to fulltext articles. The following is a sample of items found for hernia in the PubMed Central database: ·

A role for the collagen I/III and MMP-1/-13 genes in primary inguinal hernia? by Rosch R, Klinge U, Si Z, Junge K, Klosterhalfen B, Schumpelick V.; 2002; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=65699

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Advice on driving after groin hernia surgery in the United Kingdom: questionnaire survey. by Ismail W, Taylor SJ, Beddow E.; 2000 Oct 28; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=27514

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Cardiac Herniation and Torsion after Partial Pericardiectomy during Right Pneumonectomy. by Buniva P, Aluffi A, Rescigno G, Rademacher J, Nazari S.; 2001; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=101140

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Impact of NICE guidance on laparoscopic surgery for inguinal hernias: analysis of interrupted time series. by Bloor K, Freemantle N, Khadjesari Z, Maynard A.; 2003 Mar 15; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=151520

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Lung Hernia as a Sequela to Limited-Access Mitral Valve Surgery. by Gouda H, Multz AS, Khan A, Rossoff LJ, Green D, Graver LM.; 2002; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=124760

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Open tension free repair of inguinal hernias; the Lichtenstein technique. by Sakorafas GH, Halikias I, Nissotakis C, Kotsifopoulos N, Stavrou A, Antonopoulos C, Kassaras GA.; 2001; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=59657

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Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html.

With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print.

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Prospective randomised controlled trial of laparoscopic versus open inguinal hernia mesh repair: five year follow up. by Douek M, Smith G, Oshowo A, Stoker DL, Wellwood JM.; 2003 May 10; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=154759

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Randomised controlled trial of laparoscopic versus open mesh repair for inguinal hernia: outcome and cost. by Wellwood J, Sculpher MJ, Stoker D, Nicholls GJ, Geddes C, Whitehead A, Singh R, Spiegelhalter D.; 1998 Jul 11; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=28600

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Spontaneous paracentesis through an umbilical hernia. by Podymow T, Sabbagh C, Turnbull J.; 2003 Mar 18; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=154926

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Surgical physiology of inguinal hernia repair - a study of 200 cases. by Desarda MP.; 2003; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=155644

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with hernia, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “hernia” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for hernia (hyperlinks lead to article summaries): ·

A case of a fetus with gastric perforation associated with congenital diaphragmatic hernia. Author(s): Hyodo H, Nitsu T, Yoshizawa K, Unno N, Aoki T, Taketani Y. Source: Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2002 November; 20(5): 518-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12423495&dopt=Abstract

6 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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A case of incarcerated lesser sac hernia protruding simultaneously through both the gastrocolic and gastrohepatic omenta. Author(s): Okayasu K, Tamamoto F, Nakanishi A, Takanashi T, Maehara T. Source: Radiat Med. 2002 March-April; 20(2): 105-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12041699&dopt=Abstract

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A case of large ventricular septal defect with right-sided diaphragmatic hernia. Author(s): Hashimoto I, Ichida F, Miyawaki T. Source: Cardiology in the Young. 2003 February; 13(1): 109-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12691298&dopt=Abstract

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A comparison of the oxidative stress response and antioxidant capacity of open and laparoscopic hernia repairs. Author(s): Polat C, Kahraman A, Yilmaz S, Koken T, Serteser M, Akbulut G, Arikan Y, Dilek ON, Gokce O. Source: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A. 2003 June; 13(3): 167-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12855098&dopt=Abstract

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A congenital anterior diaphragmatic hernia with massive pericardial effusion requiring neither emergency pericardiocentesis nor operation. A case report and review of the literature. Author(s): Ikeda K, Hokuto I, Tokieda K, Nishimura O, Ishimoto H, Morikawa Y. Source: Journal of Perinatal Medicine. 2002; 30(4): 336-40. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12235724&dopt=Abstract

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A cost--utility analysis of treatment options for inguinal hernia in 1,513,008 adult patients. Author(s): Stylopoulos N, Gazelle GS, Rattner DW. Source: Surgical Endoscopy. 2003 February; 17(2): 180-9. Epub 2002 November 06. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12415334&dopt=Abstract

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A leiomyomatous perineal hernia? Author(s): Jermy KV, Stanton SL, Nager CW, Kumar D. Source: British Journal of Obstetrics and Gynaecology. 1999 May; 106(5): 507-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10430205&dopt=Abstract

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A massive hiatal hernia that mimics a congenital diaphragmatic hernia. An unusual presentation of hiatal hernia in childhood: report of a case. Author(s): Herek O, Yildiran N. Source: Surgery Today. 2002; 32(12): 1072-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12541025&dopt=Abstract

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A population-based study of congenital diaphragmatic hernia: impact of associated anomalies and preoperative blood gases on survival. Author(s): Kaiser JR, Rosenfeld CR. Source: Journal of Pediatric Surgery. 1999 August; 34(8): 1196-202. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10466595&dopt=Abstract

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A prospective study of 1000 hernias: results of the Plymouth Hernia Service. Author(s): Kingsnorth AN, Bowley DM, Porter C. Source: Annals of the Royal College of Surgeons of England. 2003 January; 85(1): 18-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12585625&dopt=Abstract

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A prospective, randomized pilot trial of perfluorocarbon-induced lung growth in newborns with congenital diaphragmatic hernia. Author(s): Hirschl RB, Philip WF, Glick L, Greenspan J, Smith K, Thompson A, Wilson J, Adzick NS. Source: Journal of Pediatric Surgery. 2003 March; 38(3): 283-9; Discussion 283-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12632336&dopt=Abstract

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A prospective, randomized trial of laparoscopic polytetrafluoroethylene (PTFE) patch repair vs simple cruroplasty for large hiatal hernia. Author(s): Frantzides CT, Madan AK, Carlson MA, Stavropoulos GP. Source: Archives of Surgery (Chicago, Ill. : 1960). 2002 June; 137(6): 649-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12049534&dopt=Abstract

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A rare variation of Amyand's hernia. Author(s): Franko J, Raftopoulos I, Sulkowski R. Source: The American Journal of Gastroenterology. 2002 October; 97(10): 2684-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12385468&dopt=Abstract

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A retroflexed view of a hiatal hernia. Author(s): Belafsky PC, Postma GN, Koufman JA. Source: Ear, Nose, & Throat Journal. 2003 March; 82(3): 176. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12696234&dopt=Abstract

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A selective history of hernia surgery in the late eighteenth century: the treatises of Percivall Pott, Jean Louis Petit, D. August Gottlieb Richter, Don Antonio de Gimbernat, and Pieter Camper. Author(s): Rutkow IM. Source: The Surgical Clinics of North America. 2003 October; 83(5): 1021-44, V. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14533901&dopt=Abstract

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A statistical model to predict nonsurvival in congenital diaphragmatic hernia. Author(s): Springer SC, Fleming D, Hulsey TC. Source: Journal of Perinatology : Official Journal of the California Perinatal Association. 2002 June; 22(4): 263-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12032786&dopt=Abstract

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A technique for the repair of giant umbilical hernia in children. Author(s): Billmire DF. Source: Journal of the American College of Surgeons. 2002 May; 194(5): 677-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12022612&dopt=Abstract

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Abdominal incisional hernia occurring after an esophagectomy reconstructed with a gastric tube through an antesternal route: report of a case. Author(s): Saeki H, Kuwano H, Kawaguchi H, Sonoda K, Ohga T, Kitamura K, Nakashima H, Toh Y, Sugimachi K, Oiwa T. Source: Surgery Today. 1998; 28(12): 1254-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9872543&dopt=Abstract

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Abnormal esophageal anatomy associated with a congenital diaphragmatic hernia: report of a case. Author(s): Karnak I, Senocak ME, Tanyel FC, Buyukpamukcu N. Source: Surgery Today. 2001; 31(11): 1005-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11766070&dopt=Abstract

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Accidental ureteral ligation during an inguinal hernia repair of patient with crossed fused renal ectopia. Author(s): Hwang CM, Miller FH, Dalton DP, Hartz WH. Source: Clinical Imaging. 2002 September-October; 26(5): 306-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12213362&dopt=Abstract

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Acid clearance, hiatal hernia size and oesophagitis: redress the egress regress. Author(s): Massey BT. Source: Neurogastroenterology and Motility : the Official Journal of the European Gastrointestinal Motility Society. 2002 December; 14(6): 607-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12464082&dopt=Abstract

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Acute abdomen due to internal hernia through the foramen of Winslow: CT diagnosis. Author(s): Romano S, De Lutio E, Lombardo P, Gatta G, Romano L. Source: Radiol Med (Torino). 2003 May-June; 105(5-6): 511-3. English, Italian. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12949462&dopt=Abstract

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Acute aortic thrombosis in a newborn with congenital diaphragmatic hernia masquerading as coarctation of the aorta. Author(s): Baptista MJ, Vaz T, Barreira JL, Martins A, Moreira J. Source: Rev Port Cardiol. 2002 March; 21(3): 351-3. English, Portuguese. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12017806&dopt=Abstract

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Acute appendicitis in a femoral hernia: an unusual presentation of a groin mass. Author(s): Isaacs LE, Felsenstein CH. Source: The Journal of Emergency Medicine. 2002 July; 23(1): 15-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12217466&dopt=Abstract

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Acute respiratory failure caused by an incarcerated right-sided adult bochdalek hernia: report of a case. Author(s): Kanazawa A, Yoshioka Y, Inoi O, Murase J, Kinoshita H. Source: Surgery Today. 2002; 32(9): 812-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12203061&dopt=Abstract

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Amyand's hernia. Author(s): Fernando J, Leelaratna S. Source: Ceylon Med J. 2002 June; 47(2): 71. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12140886&dopt=Abstract

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Amyand's hernia: a report of two cases. Author(s): Solecki R, Matyja A, Milanowski W. Source: Hernia : the Journal of Hernias and Abdominal Wall Surgery. 2003 March; 7(1): 50-1. Epub 2002 November 01. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12612800&dopt=Abstract

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An enormous ventral (epigastric) hernia as a cause of acute pancreatitis: Pfeffer's closed duodenal loop model in the animal, first seen in a human. Author(s): Lankisch PG, Petersen F, Brinkmann G. Source: Gastroenterology. 2003 March; 124(3): 865-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12612934&dopt=Abstract

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An unusual presentation of a lumbar hernia. Author(s): Hindmarsh A, Mehta S, Mariathas DA. Source: Emergency Medicine Journal : Emj. 2002 September; 19(5): 460. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12205008&dopt=Abstract

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An unusual presentation of metastatic gastric cancer found during inguinal hernia repair: case report and review of the literature. Author(s): Oruc MT, Kulah B, Saylam B, Moran M, Albayrak L, Coskun F. Source: Hernia : the Journal of Hernias and Abdominal Wall Surgery. 2002 July; 6(2): 8890. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12152647&dopt=Abstract

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Analysis of patients with congenital diaphragmatic hernia requiring pre-operative extracorporeal membrane oxygenation (ECMO). Author(s): Nagaya M, Kato J, Niimi N, Tanaka S, Tanaka T. Source: Pediatric Surgery International. 1998 November; 14(1-2): 25-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9880690&dopt=Abstract

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Anatomical variations of the inguinal nerves and risks of injury in 110 hernia repairs. Author(s): al-dabbagh AK. Source: Surgical and Radiologic Anatomy : Sra. 2002 May; 24(2): 102-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12197017&dopt=Abstract

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Anesthesia for groin hernia surgery. Author(s): Amado WJ. Source: The Surgical Clinics of North America. 2003 October; 83(5): 1065-77. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14533904&dopt=Abstract

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Antenatal betamethasone and favourable outcomes in fetuses with 'poor prognosis' diaphragmatic hernia. Author(s): Ford WD, Kirby CP, Wilkinson CS, Furness ME, Slater AJ. Source: Pediatric Surgery International. 2002 May; 18(4): 244-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12021971&dopt=Abstract

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Antibiotic prophylaxis for hernia repair. Author(s): Sanchez-Manuel FJ, Seco-Gil JL. Source: Cochrane Database Syst Rev. 2003; (2): Cd003769. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12804490&dopt=Abstract

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Antibiotic prophylaxis in incisional hernia repair using a prosthesis. Author(s): Rios A, Rodriguez JM, Munitiz V, Alcaraz P, Perez Flores D, Parrilla P. Source: Hernia : the Journal of Hernias and Abdominal Wall Surgery. 2001 September; 5(3): 148-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11759801&dopt=Abstract

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Assessing the costs and consequences of laparoscopic vs. open methods of groin hernia repair: a systematic review. Author(s): Vale L, Ludbrook A, Grant A. Source: Surgical Endoscopy. 2003 June; 17(6): 844-9. Epub 2003 March 14. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12632125&dopt=Abstract

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Association between prepregnancy maternal body mass index and the risk of having an infant with a congenital diaphragmatic hernia. Author(s): Waller DK, Tita AT, Werler MM, Mitchell AA. Source: Birth Defects Research. Part A, Clinical and Molecular Teratology. 2003 January; 67(1): 73-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12749387&dopt=Abstract

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Attendance at a pain clinic with severe chronic pain after open and laparoscopic inguinal hernia repairs. Author(s): Hindmarsh AC, Cheong E, Lewis MP, Rhodes M. Source: The British Journal of Surgery. 2003 September; 90(9): 1152-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12945086&dopt=Abstract

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Back to work more quickly after an inguinal hernia repair. Author(s): Ambach R, Weiss W, Sexton JL, Russo A. Source: Military Medicine. 2000 October; 165(10): 747-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11050871&dopt=Abstract

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Balloon tracheal occlusion for congenital diaphragmatic hernia: experimental studies. Author(s): Chiba T, Albanese CT, Farmer DL, Dowd CF, Filly RA, Machin GA, Harrison M. Source: Journal of Pediatric Surgery. 2000 November; 35(11): 1566-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11083424&dopt=Abstract

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BAPS prize-1999: Lung growth induced by prenatal tracheal occlusion and its modifying factors: a study in the rat model of congenital diaphragmatic hernia. Author(s): Kitano Y, Kanai M, Davies P, von Allmen D, Yang EY, Radu A, Kitano Y, Adzick NS, Flake AW. Source: Journal of Pediatric Surgery. 2001 February; 36(2): 251-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11172410&dopt=Abstract

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Barrett's esophagus, hiatal hernia, and logistic regression analysis. Author(s): El-Serag HB. Source: The American Journal of Gastroenterology. 1999 December; 94(12): 3395-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10606286&dopt=Abstract

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Barrett's esophagus: prevalence and size of hiatal hernia. Author(s): Cameron AJ. Source: The American Journal of Gastroenterology. 1999 August; 94(8): 2054-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10445527&dopt=Abstract

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Bassini vs Lichtenstein: two basic techniques for inguinal hernia treatment. Author(s): Maggiore D, Muller G, Hafanaki J. Source: Hernia : the Journal of Hernias and Abdominal Wall Surgery. 2001 March; 5(1): 21-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11387718&dopt=Abstract

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Best practice in groin hernia repair. Author(s): Macintyre IM. Source: The British Journal of Surgery. 2003 February; 90(2): 131-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12555287&dopt=Abstract

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Bilateral arcuate-line hernia. Author(s): Cappeliez O, Duez V, Alle JL, Leclercq F. Source: Ajr. American Journal of Roentgenology. 2003 March; 180(3): 864-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12591715&dopt=Abstract

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Bilateral congenital diaphragmatic hernia. Author(s): Neville HL, Jaksic T, Wilson JM, Lally PA, Hardin WD Jr, Hirschl RB, Lally KP; Congenital Diaphragmatic Hernia Study Group. Source: Journal of Pediatric Surgery. 2003 March; 38(3): 522-4. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12632380&dopt=Abstract

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Bilateral congenital diaphragmatic hernia: diagnostic clues at fetal sonography. Author(s): Song MS, Yoo SJ, Smallhorn JF, Mullen JB, Ryan G, Hornberger LK. Source: Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2001 March; 17(3): 255-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11309179&dopt=Abstract

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Bilateral congenital diaphragmatic hernia: Differentiation between Pallister-Killian and Fryns syndromes. Author(s): Veldman A, Schlosser R, Allendorf A, Fischer D, Heller K, Schaeff B, Fuchs S. Source: American Journal of Medical Genetics. 2002 July 22; 111(1): 86-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12124742&dopt=Abstract

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Bilateral cryptorchidism with bilateral inguinal hernia and retrovesical mass in an infertile man: single-stage laparoscopic management. Author(s): Ansari MS, Mandal S, Ray R, Hemal AK. Source: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A. 2002 February; 12(1): 73-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11905867&dopt=Abstract

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Bilateral diaphragmatic agenesis in an adult complicated by a paraduodenal hernia. Author(s): Anderson CD, Eliason J, Roberts JR, Sharp KW. Source: The American Surgeon. 2003 June; 69(6): 523-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12852512&dopt=Abstract

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Bilateral diaphragmatic hernia followed by fetal ultrasonography. A report of two cases. Author(s): Kamata S, Sawai T, Usui N, Nose K, Kitayama Y, Nakai H, Okuyama H, Okada A, Kawaguchi H, Chiba Y. Source: Fetal Diagnosis and Therapy. 2001 July-August; 16(4): 248-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11399890&dopt=Abstract

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Bilateral inguinal hernia repaired by laparoscopic technique: a rare complication of femorofemoral bypass. Author(s): Kawamura YJ, Futakawa N, Oshiro H, Yasuhara H, Shigematsu H, Muto T. Source: Surgical Endoscopy. 1999 November; 13(11): 1157-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10556461&dopt=Abstract

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Bilateral laparoscopic inguinal hernia repair can complicate subsequent radical retropubic prostatectomy. Author(s): Katz EE, Patel RV, Sokoloff MH, Vargish T, Brendler CB. Source: The Journal of Urology. 2002 February; 167(2 Pt 1): 637-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11792935&dopt=Abstract

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Bilateral lumbar hernia associated with abdominal hernias. A case report. Author(s): Cocozza E, Pidoto RR, Ravera M. Source: Minerva Chir. 1999 June; 54(6): 421-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10479862&dopt=Abstract

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Bilateral lung transplantation for pulmonary hypoplasia caused by congenital diaphragmatic hernia. Author(s): Lee R, Mendeloff EN, Huddleston C, Sweet SC, de la Morena M. Source: The Journal of Thoracic and Cardiovascular Surgery. 2003 July; 126(1): 295-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12878973&dopt=Abstract

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Biomechanical and morphological types of the linea alba and its possible role in the pathogenesis of midline incisional hernia. Author(s): Korenkov M, Beckers A, Koebke J, Lefering R, Tiling T, Troidl H. Source: The European Journal of Surgery = Acta Chirurgica. 2001 December; 167(12): 909-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11841081&dopt=Abstract

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Bladder cancer within a direct inguinal hernia: CT demonstration. Author(s): Caterino M, Finocchi V, Giunta S, De Carli P, Crecco M. Source: Abdominal Imaging. 2001 November-December; 26(6): 664-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11907736&dopt=Abstract

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Bochdalek diaphragmatic hernia presenting with acute gastric dilatation. Author(s): Quah BS, Hashim I, Simpson H. Source: Journal of Pediatric Surgery. 1999 March; 34(3): 512-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10211672&dopt=Abstract

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Bochdalek diaphragmatic hernia: not only a neonatal disease. Author(s): Mei-Zahav M, Solomon M, Trachsel D, Langer JC. Source: Archives of Disease in Childhood. 2003 June; 88(6): 532-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12765926&dopt=Abstract

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Bochdalek hernia in adult. Author(s): Kao CL. Source: The Journal of Emergency Medicine. 2002 October; 23(3): 283-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12426025&dopt=Abstract

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Bochdalek hernia in adulthood: a case report and review of recent literature. Author(s): Jastaniah S, el-Tahir MI, Grillo IA, Batouk A, al-Shehry MY, Softah A, el-D N el-Tayeb. Source: Indian J Chest Dis Allied Sci. 1998 October-December; 40(4): 281-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10091469&dopt=Abstract

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Bochdalek's hernia in adults. Author(s): Bujanda L, Larrucea I, Ramos F, Munoz C, Sanchez A, Fernandez I. Source: Journal of Clinical Gastroenterology. 2001 February; 32(2): 155-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11205653&dopt=Abstract

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Bochdalek's hernia in the adult. Author(s): Mylarappa P, Ramachandra L, Kumar PS. Source: J Indian Med Assoc. 1998 March; 96(3): 100. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9828563&dopt=Abstract

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Bochodalek hernia in a young adult: report of a case. Author(s): Kubota K, Yamaguchi H, Kawahara M, Kaminishi M. Source: Surgery Today. 2001; 31(4): 322-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11321341&dopt=Abstract

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Bowel obstruction following liver transplantation: clinical and ct findings in 48 cases with emphasis on internal hernia. Author(s): Blachar A, Federle MP. Source: Radiology. 2001 February; 218(2): 384-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11161150&dopt=Abstract

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Bowel obstruction in the postoperative period of laparoscopic inguinal hernia repair (TAPP): review of the literature. Author(s): Cueto J, Vazquez JA, Solis MA, Valdez G, Valencia S, Weber A. Source: Jsls. 1998 July-September; 2(3): 277-80. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9876754&dopt=Abstract

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Bubo masquerading as an incarcerated inguinal hernia. Author(s): Hodge KR, Orgler RJ, Monson T, Read RC. Source: Hernia : the Journal of Hernias and Abdominal Wall Surgery. 2001 June; 5(2): 978. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11505657&dopt=Abstract

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Cardiovascular malformations in experimental congenital diaphragmatic hernia. Author(s): Losty PD, Connell MG, Freese R, Laval S, Okoye BO, Smith A, Kluth D, Lloyd DA. Source: Journal of Pediatric Surgery. 1999 August; 34(8): 1203-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10466596&dopt=Abstract

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Case in point. Lung hernia. Author(s): Parenti DJ, Fischer MB. Source: Hosp Pract (Off Ed). 1999 July 15; 34(7): 68. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10418552&dopt=Abstract

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Case of the season. Foramen of Morgagni hernia. Author(s): Hinshaw LJ, Collins J. Source: Semin Roentgenol. 2002 January; 37(1): 3-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11987764&dopt=Abstract

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Case report: pericecal hernia: a report of two cases and survey of the literature. Author(s): Lu HC, Wang J, Tsang YM, Tseng HS, Li YW. Source: Clinical Radiology. 2002 September; 57(9): 855-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12384115&dopt=Abstract

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Causative factors, surgical treatment and outcome of incisional hernia after liver transplantation. Author(s): Janssen H, Lange R, Erhard J, Malago M, Eigler FW, Broelsch CE. Source: The British Journal of Surgery. 2002 August; 89(8): 1049-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12153634&dopt=Abstract

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Central mesh recurrence after incisional hernia repair with Marlex--are the meshes strong enough? Author(s): Langer C, Neufang T, Kley C, Liersch T, Becker H. Source: Hernia : the Journal of Hernias and Abdominal Wall Surgery. 2001 September; 5(3): 164-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11759806&dopt=Abstract

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Challenging embryological theories on congenital diaphragmatic hernia: future therapeutic implications for paediatric surgery. Author(s): Jesudason EC. Source: Annals of the Royal College of Surgeons of England. 2002 July; 84(4): 252-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12215028&dopt=Abstract

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Changing the path of inguinal hernia surgery decreased the recurrence rate ten-fold. Report from a county hospital. Author(s): Bemdsen F, Sevonius D. Source: The European Journal of Surgery = Acta Chirurgica. 2002; 168(11): 592-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12699094&dopt=Abstract

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Choledochal semi volvulus with jaundice due to hiatal hernia. Initial percutaneous management. Author(s): Caldeiro JC, Curcio A, Gigena VC, Barbarosa G. Source: Acta Gastroenterol Latinoam. 2001 October; 31(4): 329-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11766545&dopt=Abstract

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Chronic liver herniation through a right Bochdalek hernia with acute onset in adulthood. Author(s): Fisichella PM, Perretta S, Di Stefano A, Di Carlo I, La Greca G, Russello D, Latteri F. Source: Ann Ital Chir. 2001 November-December; 72(6): 703-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12061222&dopt=Abstract

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Chronic pain after laparoscopic and open mesh repair of groin hernia (Br J Surg 2002; 89: 1476-1479). Author(s): Losanoff JE, Richman BW, Jones JW. Source: The British Journal of Surgery. 2003 March; 90(3): 368. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12594678&dopt=Abstract

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Chronic pain after laparoscopic and open mesh repair of groin hernia. Author(s): Kumar S, Wilson RG, Nixon SJ, Macintyre IM. Source: The British Journal of Surgery. 2002 November; 89(11): 1476-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12390395&dopt=Abstract

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Colon ischaemia from a stammers hernia: a long-term complication after Billroth II gastrectomy. Author(s): Ooi EH, Pathma-Nathan N, Hewett PJ, Bridgewater FJ. Source: Anz Journal of Surgery. 2002 August; 72(8): 601-3. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12190739&dopt=Abstract

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Complications of open groin hernia repairs. Author(s): Stephenson BM. Source: The Surgical Clinics of North America. 2003 October; 83(5): 1255-78. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14533914&dopt=Abstract

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Complications of umbilical vein catheterization: neonatal total parenteral nutrition ascites after surgical repair of congenital diaphragmatic hernia. Author(s): Nakstad B, Naess PA, de Lange C, Schistad O. Source: Journal of Pediatric Surgery. 2002 August; 37(8): E21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12149721&dopt=Abstract

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Computed tomography of traumatic abdominal wall hernia and associated deceleration injuries. Author(s): Hickey NA, Ryan MF, Hamilton PA, Bloom C, Murphy JP, Brenneman F. Source: Canadian Association of Radiologists Journal = Journal L'association Canadienne Des Radiologistes. 2002 June; 53(3): 153-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12101537&dopt=Abstract

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Congenital “transhaesio intestini tenuis supragastrica” in a 14-year-old girl - a rare case of internal hernia. Author(s): Bahadori K, Mayr J, Schleef J. Source: European Journal of Pediatric Surgery : Official Journal of Austrian Association of Pediatric Surgery. [et Al] = Zeitschrift Fur Kinderchirurgie. 2003 February; 13(1): 54-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12664417&dopt=Abstract

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Congenital bronchobiliary fistula in association with right-sided congenital diaphragmatic hernia. Author(s): DiFiore JW, Alexander F. Source: Journal of Pediatric Surgery. 2002 August; 37(8): 1208-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12149705&dopt=Abstract

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Congenital diaphragmatic hernia and hydrops: a lethal association? Author(s): Sydorak RM, Goldstein R, Hirose S, Tsao K, Farmer DL, Lee H, Harrison MR, Albanese CT. Source: Journal of Pediatric Surgery. 2002 December; 37(12): 1678-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12483628&dopt=Abstract

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Congenital diaphragmatic hernia associated with aplasia of left lobe of the liver. Author(s): Dharmik A, Gupta PR, Menon P, Mittal BR, Mahajan JK, Samujh R, Rao KL. Source: Journal of Pediatric Surgery. 2003 July; 38(7): E21-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12861596&dopt=Abstract

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Congenital diaphragmatic hernia in a female patient with craniofrontonasal syndrome. Author(s): Brooks AS, van Dooren M, Hoogeboom J, Gischler S, Willems PJ, Tibboel D. Source: Clinical Dysmorphology. 2002 April; 11(2): 151-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12002152&dopt=Abstract

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Congenital diaphragmatic hernia in Scandinavia from 1995 to 1998: Predictors of mortality. Author(s): Skari H, Bjornland K, Frenckner B, Friberg LG, Heikkinen M, Hurme T, Loe B, Mollerlokken G, Nielsen OH, Qvist N, Rintala R, Sandgren K, Wester T, Emblem R. Source: Journal of Pediatric Surgery. 2002 September; 37(9): 1269-75. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12194115&dopt=Abstract

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Congenital diaphragmatic hernia. Author(s): Smith NP, Jesudason EC, Losty PD. Source: Paediatric Respiratory Reviews. 2002 December; 3(4): 339-48. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12457605&dopt=Abstract

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Congenital diaphragmatic hernia. Author(s): Karamanoukian HL, Glick PL. Source: The Annals of Thoracic Surgery. 2003 March; 75(3): 1059-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12645753&dopt=Abstract

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Congenital diaphragmatic hernia. Author(s): Bohn D. Source: American Journal of Respiratory and Critical Care Medicine. 2002 October 1; 166(7): 911-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12359645&dopt=Abstract

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Congenital diaphragmatic hernia. Author(s): Lally KP. Source: Current Opinion in Pediatrics. 2002 August; 14(4): 486-90. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12130916&dopt=Abstract

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Congenital diaphragmatic hernia. Two cases with early prenatal diagnosis and increased nuchal translucency. Author(s): Varlet F, Bousquet F, Clemenson A, Chauleur C, Kopp-Dutour N, Tronchet M, Teyssier G, Prieur F, Varlet MN. Source: Fetal Diagnosis and Therapy. 2003 January-February; 18(1): 33-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12566773&dopt=Abstract

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Congenital diaphragmatic hernia: advances in prenatal therapy. Author(s): Sydorak RM, Harrison MR. Source: Clin Perinatol. 2003 September; 30(3): 465-79. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14533889&dopt=Abstract

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Congenital diaphragmatic hernia: advances in prenatal therapy. Author(s): Sydorak RM, Harrison MR. Source: World Journal of Surgery. 2003 January; 27(1): 68-76. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12557040&dopt=Abstract

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Congenital paraesophageal hiatal hernia. Author(s): Hendrickson RJ, Fenton L, Hall D, Karrer FM. Source: Journal of the American College of Surgeons. 2003 March; 196(3): 483. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12648703&dopt=Abstract

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Contralateral exploration is not mandatory in unilateral inguinal hernia in children: a prospective 6-year study. Author(s): Nassiri SJ. Source: Pediatric Surgery International. 2002 September; 18(5-6): 470-1. Epub 2002 July 20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12415383&dopt=Abstract

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Contralateral groin exploration is not justified in infants with a unilateral inguinal hernia. Author(s): Shabbir J, Moore A, O'Sullivan JB, Delaney PV, Drumm J, Flood H, Grace PA. Source: Ir J Med Sci. 2003 January-March; 172(1): 18-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12760457&dopt=Abstract

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Cost-effective, reliable laparoscopic hernia repair: a report on 500 consecutive repairs. Author(s): Fazzio FJ Jr. Source: Surgical Endoscopy. 2002 June; 16(6): 931-5. Epub 2002 February 27. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12163957&dopt=Abstract

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Could incarceration of inguinal hernia in children be prevented? Author(s): Niedzielski J, Kr l R, Gawlowska A. Source: Medical Science Monitor : International Medical Journal of Experimental and Clinical Research. 2003 January; 9(1): Cr16-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12552244&dopt=Abstract

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Craniofrontonasal syndrome and diaphragmatic hernia. Author(s): McGaughran J, Rees M, Battin M. Source: American Journal of Medical Genetics. 2002 July 15; 110(4): 391-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12116215&dopt=Abstract

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CT of internal hernia through a peritoneal defect of the pouch of Douglas. Author(s): Inoue Y, Shibata T, Ishida T. Source: Ajr. American Journal of Roentgenology. 2002 November; 179(5): 1305-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12388518&dopt=Abstract

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CT technique for suspected anterior abdominal wall hernia. Author(s): Emby DJ, Aoun G. Source: Ajr. American Journal of Roentgenology. 2003 August; 181(2): 431-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12876022&dopt=Abstract

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Current and emerging treatment for congenital diaphragmatic hernia. Author(s): Braby J. Source: Neonatal Netw. 2001 March; 20(2): 5-15. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12144112&dopt=Abstract

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Current concepts in the management of paraesophageal hiatal hernia. Author(s): Hashemi M, Sillin LF, Peters JH. Source: Journal of Clinical Gastroenterology. 1999 July; 29(1): 8-13. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10405224&dopt=Abstract

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Current status of laparoscopic ventral hernia repair. Author(s): Thoman DS, Phillips EH. Source: Surgical Endoscopy. 2002 June; 16(6): 939-42. Epub 2002 February 27. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12163959&dopt=Abstract

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Danish nationwide cohort study of postoperative death in patients with liver cirrhosis undergoing hernia repair. Author(s): Hansen JB, Thulstrup AM, Vilstup H, Sorensen HT. Source: The British Journal of Surgery. 2002 June; 89(6): 805-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12027997&dopt=Abstract

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Day-case laparoscopic hernia repair in a single unit. Author(s): McCloud JM, Evans DS. Source: Surgical Endoscopy. 2003 March; 17(3): 491-3. Epub 2002 November 06. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12415338&dopt=Abstract

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Deep prosthesis infection in incisional hernia repair: predictive factors and clinical outcome. Author(s): Petersen S, Henke G, Freitag M, Faulhaber A, Ludwig K. Source: The European Journal of Surgery = Acta Chirurgica. 2001 June; 167(6): 453-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11471671&dopt=Abstract

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Definitive surgical treatment of infected or exposed ventral hernia mesh. Author(s): Szczerba SR, Dumanian GA. Source: Annals of Surgery. 2003 March; 237(3): 437-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12616130&dopt=Abstract

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Delayed presentation of bilateral Morgagni's hernia in a child with Down's Syndrome. Author(s): Al-Salem AH, Khawaher HA. Source: Saudi Med J. 2002 February; 23(2): 237-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11938406&dopt=Abstract

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Delayed presentation of congenital diaphragmatic hernia in association with group B streptococcus infection in a preterm Omani neonate. Author(s): Manzar S, Nair PM, Nayar M. Source: Saudi Med J. 2000 May; 21(5): 487-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11500688&dopt=Abstract

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Delayed presentation of congenital diaphragmatic hernia. Author(s): Elhalaby EA, Abo Sikeena MH. Source: Pediatric Surgery International. 2002 September; 18(5-6): 480-5. Epub 2002 July 31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12415386&dopt=Abstract

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Delayed presentation of diaphragmatic hernia with intra-thoracic pseudo kidney sign. Author(s): Subhash HS, Raghuram L, Gnanamuthu BR, Roy A, Cherian AM. Source: Indian J Chest Dis Allied Sci. 2003 January-March; 45(1): 51-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12683711&dopt=Abstract

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Delayed presentation of esophageal perforation simulating paraesophageal hernia. Author(s): Qureshi R, Tanchel B, Khalil Marzouk JF. Source: Diseases of the Esophagus : Official Journal of the International Society for Diseases of the Esophagus / I.S.D.E. 2001; 14(2): 159-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11553229&dopt=Abstract

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Delayed presentation of traumatic diaphragmatic hernia. Author(s): Kulstad EB, Pisano MV, Shirakbari AA. Source: The Journal of Emergency Medicine. 2003 May; 24(4): 455-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12745051&dopt=Abstract

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Delayed presentations of congenital diaphragmatic hernia. Author(s): Singh S, Bhende MS, Kinnane JM. Source: Pediatric Emergency Care. 2001 August; 17(4): 269-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11493830&dopt=Abstract

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Deletion 15q24-26 in prenatally detected diaphragmatic hernia: increasing evidence of a candidate region for diaphragmatic development. Author(s): Schlembach D, Zenker M, Trautmann U, Ulmer R, Beinder E. Source: Prenatal Diagnosis. 2001 April; 21(4): 289-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11288119&dopt=Abstract

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Demographic and socioeconomic aspects of hernia repair in the United States in 2003. Author(s): Rutkow IM. Source: The Surgical Clinics of North America. 2003 October; 83(5): 1045-51, V-Vi. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14533902&dopt=Abstract

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Diagnosing the occult contralateral inguinal hernia. Author(s): Koehler RH. Source: Surgical Endoscopy. 2002 March; 16(3): 512-20. Epub 2001 November 16. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11928039&dopt=Abstract

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Diagnosis and surgical treatment of Morgagni hernia: report of three cases. Author(s): Kurkcuoglu IC, Eroglu A, Karaoglanoglu N, Polat P, Balik AA, Tekinbas C. Source: Surgery Today. 2003; 33(7): 525-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14506998&dopt=Abstract

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Diagnosis and treatment of obturator hernia. Author(s): Nakayama T, Kobayashi S, Shiraishi K, Nishiumi T, Mori S, Isobe K, Furuta Y. Source: Keio J Med. 2002 September; 51(3): 129-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12371643&dopt=Abstract

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Diagnosis and treatment of primary incarcerated lumbar hernia. Author(s): Losanoff JE, Kjossev KT. Source: The European Journal of Surgery = Acta Chirurgica. 2002; 168(3): 193-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12182246&dopt=Abstract

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Diagnosis and treatment of sportsman's hernia. Author(s): Joesting DR. Source: Curr Sports Med Rep. 2002 April; 1(2): 121-4. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12831721&dopt=Abstract

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Diagnosis of a femoral hernia in the elective setting. Author(s): Hair A, Paterson C, O'Dwyer PJ. Source: Journal of the Royal College of Surgeons of Edinburgh. 2001 April; 46(2): 117-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11329740&dopt=Abstract

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Diaphragmatic hernia after Ivor-Lewis esophagectomy manifested as lower gastrointestinal bleeding. Author(s): Choi YU, North JH Jr. Source: The American Surgeon. 2001 January; 67(1): 30-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11206892&dopt=Abstract

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Diaphragmatic hernia seen as a late complication of laparoscopic cholecystectomy. Author(s): Armstrong PA, Miller SF, Brown GR. Source: Surgical Endoscopy. 1999 August; 13(8): 817-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10430694&dopt=Abstract

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Diaphragmatic hernia with homolateral limb reduction. Author(s): Herman TE, Siegel MJ. Source: Journal of Perinatology : Official Journal of the California Perinatal Association. 2001 September; 21(6): 412-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11593381&dopt=Abstract

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Diaphragmatic hernia, hydrocephalus, and cardiac malformations in four pregnancies of a non-consanguineous couple. Author(s): Delozier-Blanchet CD, Lespinasse J, Brundler MA, Extermann P. Source: Journal of Medical Genetics. 2001 April; 38(4): 269-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11370634&dopt=Abstract

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Diaphragmatic hernia: an unusual cause of postpartum collapse. Author(s): Sharifah H, Naidu A, Vimal K. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2003 July; 110(7): 701-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12842063&dopt=Abstract

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Diaphragmatic perforation and hernia after hepatic radiofrequency ablation. Author(s): Koda M, Ueki M, Maeda N, Murawaki Y. Source: Ajr. American Journal of Roentgenology. 2003 June; 180(6): 1561-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12760919&dopt=Abstract

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Direct inguinal hernia strangulating through the superficial inguinal ring. Author(s): Awad ZT. Source: Ir Med J. 2001 November-December; 94(10): 313. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11837633&dopt=Abstract

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Disability and chronic pain after open mesh and laparoscopic inguinal hernia repair. Author(s): Bozuk M, Schuster R, Stewart D, Hicks K, Greaney G, Waxman K. Source: The American Surgeon. 2003 October; 69(10): 839-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14570359&dopt=Abstract

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Dispositional pessimism predicts delayed return to normal activities after inguinal hernia operation. Author(s): Bowley DM, Butler M, Shaw S, Kingsnorth AN. Source: Surgery. 2003 February; 133(2): 141-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12605174&dopt=Abstract

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Diverticulitis presenting as a strangulated inguinal hernia. Author(s): Girotto JA, Shaikh AY, Freeswick PD, Todd LB, Harmon JW. Source: Digestive Surgery. 2002; 19(1): 67-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11961361&dopt=Abstract

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Do ex-premature infants need mechanical ventilation for inguinal hernia repair? Author(s): Bouchut JC, Claris O. Source: British Journal of Anaesthesia. 2002 February; 88(2): 301-2; Author Reply 302. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11878667&dopt=Abstract

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Does every hernia demand a mesh repair? A critical review. Author(s): Schumpelick V. Source: Hernia : the Journal of Hernias and Abdominal Wall Surgery. 2001 March; 5(1): 5-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11387724&dopt=Abstract

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Does means of access affect the incidence of small bowel obstruction and ventral hernia after bowel resection? Laparoscopy versus laparotomy. Author(s): Duepree HJ, Senagore AJ, Delaney CP, Fazio VW. Source: Journal of the American College of Surgeons. 2003 August; 197(2): 177-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12892794&dopt=Abstract

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Does V-A ECMO increase the likelihood of chylothorax after congenital diaphragmatic hernia repair? Author(s): Hanekamp MN, Tjin A Djie GC, van Hoek-Ottenkamp WG, Hazebroek FW, Tibboel D, Postema RR. Source: Journal of Pediatric Surgery. 2003 June; 38(6): 971-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12778405&dopt=Abstract

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Double omental hernia--case report on a very rare cause of intestinal obstruction. Author(s): See JY, Ong AW, Iau PT, Chan ST. Source: Ann Acad Med Singapore. 2002 November; 31(6): 799-801. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12520837&dopt=Abstract

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Double vagina with sex reversal, congenital diaphragmatic hernia, pulmonary and cardiac malformations--another case of Meacham syndrome. Author(s): Killeen OG, Kelehan P, Reardon W. Source: Clinical Dysmorphology. 2002 January; 11(1): 25-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11822701&dopt=Abstract

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Down-regulation of sonic hedgehog expression in pulmonary hypoplasia is associated with congenital diaphragmatic hernia. Author(s): Unger S, Copland I, Tibboel D, Post M. Source: American Journal of Pathology. 2003 February; 162(2): 547-55. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12547712&dopt=Abstract

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Driving after hernia surgery. Claims in editorial from Lichtenstein Hernia Institute are unsubstantiated. Author(s): Slater GH, Hopkins G, Bailey M. Source: Bmj (Clinical Research Ed.). 2001 March 24; 322(7288): 736. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11293421&dopt=Abstract

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Driving after hernia surgery. Patients should be advised not to drive for 10 days. Author(s): Colin JF. Source: Bmj (Clinical Research Ed.). 2001 March 24; 322(7288): 735-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11293420&dopt=Abstract

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Drug resistant neonatal Candida tropicalis septicemia. Did it cause diaphragmatic hernia? Author(s): Dutta S, Narang A. Source: Indian Pediatrics. 2003 March; 40(3): 261-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12657764&dopt=Abstract

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Duplex ultrasonography in diagnosis of spigelian hernia with incarcerated jejunal loop. Author(s): Buljevac M, Grgurevic I, Lackovic Z, Kujundzic M, Banic M. Source: Acta Med Croatica. 2001; 55(4-5): 225-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12398029&dopt=Abstract

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Early perfluorodecalin lung distension in infants with congenital diaphragmatic hernia. Author(s): Walker GM, Kasem KF, O'Toole SJ, Watt A, Skeoch CH, Davis CF. Source: Journal of Pediatric Surgery. 2003 January; 38(1): 17-20; Discussion 17-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12592611&dopt=Abstract

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Early results of inguinal hernia repair by the 'mesh plug' technique--first 200 cases. Author(s): Fasih T, Mahapatra TK, Waddington RT. Source: Annals of the Royal College of Surgeons of England. 2000 November; 82(6): 396400. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11103156&dopt=Abstract

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Early sepsis, obstructive jaundice and right-sided diaphragmatic hernia in the newborn. Author(s): Garcia-Munoz F, Santana C, Reyes D, Wiehoff A, Lopez-Pinto JM, GarciaAlix A. Source: Acta Paediatrica (Oslo, Norway : 1992). 2001 January; 90(1): 96-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11227344&dopt=Abstract

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Echocardiographic predictors of outcome in newborns with congenital diaphragmatic hernia. Author(s): Suda K, Bigras JL, Bohn D, Hornberger LK, McCrindle BW. Source: Pediatrics. 2000 May; 105(5): 1106-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10790470&dopt=Abstract

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Editor's note: How we do it: repair of recurrent inguinal hernia. Author(s): Teich S, Caniano DA. Source: Semin Pediatr Surg. 2003 May; 12(2): 89. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12728392&dopt=Abstract

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Effect of AGEs on human disc herniation: intervertebral disc hernia is also effected by AGEs. Author(s): Tsuru M, Nagata K, Jimi A, Irie K, Yamada A, Nagai R, Horiuchi S, Sata M. Source: Kurume Med J. 2002; 49(1-2): 7-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12235877&dopt=Abstract

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Effect of mechanical ventilation on the pulmonary expression and production of elastin in nitrofen-induced diaphragmatic hernia in rats. Author(s): Guarino N, Teramoto H, Shima H, Oue T, Puri P. Source: Journal of Pediatric Surgery. 2002 September; 37(9): 1253-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12194112&dopt=Abstract

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Effect of paraesophageal hernia repair on pulmonary function. Author(s): Low DE, Simchuk EJ. Source: The Annals of Thoracic Surgery. 2002 August; 74(2): 333-7; Discussion 337. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12173809&dopt=Abstract

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Effect of PEEP and suction via chest drain on functional residual capacity and lung compliance after surgical repair of congenital diaphragmatic hernia: preliminary observations in 5 patients. Author(s): Dinger J, Peter-Kern M, Goebel P, Roesner D, Schwarze R. Source: Journal of Pediatric Surgery. 2000 October; 35(10): 1482-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11051156&dopt=Abstract

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Effect of single-dose prophylactic ampicillin and sulbactam on wound infection after tension-free inguinal hernia repair with polypropylene mesh: the randomized, double-blind, prospective trial. Author(s): Yerdel MA, Akin EB, Dolalan S, Turkcapar AG, Pehlivan M, Gecim IE, Kuterdem E. Source: Annals of Surgery. 2001 January; 233(1): 26-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11141221&dopt=Abstract

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Efficacy and safety of caudal injection of levobupivacaine, 0.25%, in children under 2 years of age undergoing inguinal hernia repair, circumcision or orchidopexy. Author(s): Taylor R, Eyres R, Chalkiadis GA, Austin S. Source: Paediatric Anaesthesia. 2003 February; 13(2): 114-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12562483&dopt=Abstract

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Elective colonic operation and prosthetic repair of incisional hernia: does contamination contraindicate abdominal wall prosthesis use? Author(s): Birolini C, Utiyama EM, Rodrigues AJ Jr, Birolini D. Source: Journal of the American College of Surgeons. 2000 October; 191(4): 366-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11030241&dopt=Abstract

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Emergency abdominal surgery for sigmoid mesocolic hernia. Author(s): Yokota T, Yamada Y, Murakami Y, Yasuda M, Teshima S, Kunii Y, Yamauchi H, Sato A. Source: The American Journal of Emergency Medicine. 2002 March; 20(2): 137-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11880889&dopt=Abstract

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Emergency hernia repairs in elderly patients. Author(s): Kulah B, Duzgun AP, Moran M, Kulacoglu IH, Ozmen MM, Coskun F. Source: American Journal of Surgery. 2001 November; 182(5): 455-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11754850&dopt=Abstract

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Emergency laparoscopic repair of a paraesophageal hernia. Author(s): Nattakom T, Schuerer D, Batra S, Velonovich V, Karmy-Jones R. Source: Surgical Endoscopy. 1999 January; 13(1): 75-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9869695&dopt=Abstract

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Emergency replacement for damaged balloon dissector for laparoscopic extraperitoneal inguinal hernia repair. Author(s): Pekmezci S, Saribeyoglu K. Source: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques. 2001 August; 11(4): 289-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11525379&dopt=Abstract

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Endometriosis in a scarless abdominal wall with underlying umbilical hernia. Author(s): Ramsanahie A, Giri SK, Velusamy S, Nessim GT. Source: Ir J Med Sci. 2000 January-March; 169(1): 67. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10846866&dopt=Abstract

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Endometriosis presenting as an obstructed femoral hernia: a case report. Author(s): Makunike R, Muronda C, Saburi SD. Source: Cent Afr J Med. 2001 July; 47(7): 184-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12201030&dopt=Abstract

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Endoscopic assessment of hiatal hernia repair. Author(s): Johnson DA, Younes Z, Hogan WJ. Source: Gastrointestinal Endoscopy. 2000 November; 52(5): 650-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11060191&dopt=Abstract

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Endoscopic extraperitoneal repair of a Grynfeltt hernia. Author(s): Postema RR, Bonjer HJ. Source: Surgical Endoscopy. 2002 April; 16(4): 716. Epub 2001 December 10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11972231&dopt=Abstract

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Endoscopic inguinal hernia repair in comparison with Shouldice and Lichtenstein repair. A systematic review of randomized trials. Author(s): Schmedt CG, Leibl BJ, Bittner R. Source: Digestive Surgery. 2002; 19(6): 511-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12499747&dopt=Abstract

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Endoscopic totally preperitoneal ventral hernia repair. Author(s): Miserez M, Penninckx F. Source: Surgical Endoscopy. 2002 August; 16(8): 1207-13. Epub 2002 April 09. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12189482&dopt=Abstract

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Enterogenous duplication cyst presenting as obstructed inguinal hernia. Author(s): Iyer S, Nair S, Thapar P, Samsi AB, Kale CH, Hegde DK, Chaphekar A. Source: Indian J Gastroenterol. 1999 July-September; 18(3): 123. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10407568&dopt=Abstract

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Epigastric hernia and its etiology. Author(s): Lang B, Lau H, Lee F. Source: Hernia : the Journal of Hernias and Abdominal Wall Surgery. 2002 September; 6(3): 148-50. Epub 2002 July 13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12209306&dopt=Abstract

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Erosion and perforation of colon by synthetic mesh in a recurrent paracolostomy hernia. Author(s): Aldridge AJ, Simson JN. Source: Hernia : the Journal of Hernias and Abdominal Wall Surgery. 2001 June; 5(2): 110-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11505648&dopt=Abstract

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Esophageal hernia in dementia: surgeon's role for mixed-type esophageal hernia in an elderly woman with dementia. Author(s): Kise Y, Takahara K, Shimada H, Chino O, Tanaka H, Kenmochi T, Makuuchi H. Source: Diseases of the Esophagus : Official Journal of the International Society for Diseases of the Esophagus / I.S.D.E. 2002; 15(3): 253-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12445001&dopt=Abstract

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Esophagogastric junction opening during relaxation distinguishes nonhernia reflux patients, hernia patients, and normal subjects. Author(s): Pandolfino JE, Shi G, Trueworthy B, Kahrilas PJ. Source: Gastroenterology. 2003 October; 125(4): 1018-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14517784&dopt=Abstract

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Evaluation of mystery of the hernia sac through another perspective. Author(s): Tanyel FC, Kale G. Source: Pediatric and Developmental Pathology : the Official Journal of the Society for Pediatric Pathology and the Paediatric Pathology Society. 2001 September-October; 4(5): 512-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11779056&dopt=Abstract

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Evaluation of seprafilm and amniotic membrane as adhesion prophylaxis in mesh repair of abdominal wall hernia in rats. Author(s): Szabo A, Haj M, Waxsman I, Eitan A. Source: European Surgical Research. Europaische Chirurgische Forschung. Recherches Chirurgicales Europeennes. 2000; 32(2): 125-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10810219&dopt=Abstract

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Evidence-based management of groin hernia in primary care--a systematic review. Author(s): McIntosh A, Hutchinson A, Roberts A, Withers H. Source: Family Practice. 2000 October; 17(5): 442-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11021907&dopt=Abstract

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Evolution of an inguinal hernia surgery practice. Author(s): Mokete M, Earnshaw JJ. Source: Postgraduate Medical Journal. 2001 March; 77(905): 188-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11222828&dopt=Abstract

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Evolution of hernia repair: a salute to Professor Piero Pietri. Author(s): Nyhus LM. Source: Hernia : the Journal of Hernias and Abdominal Wall Surgery. 2001 December; 5(4): 196-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12003048&dopt=Abstract

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Excess gastroesophageal reflux in patients with hiatus hernia is caused by mechanisms other than transient LES relaxations. Author(s): van Herwaarden MA, Samsom M, Smout AJ. Source: Gastroenterology. 2000 December; 119(6): 1439-46. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11113064&dopt=Abstract

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Exchange of orotracheal tubes in a patient with difficult airway and hiatus hernia. Author(s): Asai T. Source: Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie. 2001 December; 48(11): 1171. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11744602&dopt=Abstract

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Experience with the preperitoneal 'plug and patch' inguinal hernia repair. Author(s): Ramanand B, Fayaz M, Patil P. Source: The British Journal of Surgery. 2000 April; 87(4): 517. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10809565&dopt=Abstract

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Experience--the key factor in successful laparoscopic total extraperitoneal and transabdominal preperitoneal hernia repair. Author(s): Bobrzynski A, Budzynski A, Biesiada Z, Kowalczyk M, Lubikowski J, Sienko J. Source: Hernia : the Journal of Hernias and Abdominal Wall Surgery. 2001 June; 5(2): 803. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11505653&dopt=Abstract

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Expression of surfactant proteins and thyroid transcription factor 1 in an ovine model of congenital diaphragmatic hernia. Author(s): Benachi A, Chailley-Heu B, Barlier-Mur AM, Dumez Y, Bourbon J. Source: Journal of Pediatric Surgery. 2002 October; 37(10): 1393-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12378441&dopt=Abstract

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Expression of the extracellular matrix proteins collagen I, collagen III and fibronectin and matrix metalloproteinase-1 and -13 in the skin of patients with inguinal hernia. Author(s): Klinge U, Zheng H, Si Z, Schumpelick V, Bhardwaj RS, Muys L, Klosterhalfen B. Source: European Surgical Research. Europaische Chirurgische Forschung. Recherches Chirurgicales Europeennes. 1999; 31(6): 480-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10861344&dopt=Abstract

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Extraperitoneal laparoscopic bladder neck suspension using hernia mesh and tacker. Author(s): Soygur T, Safak M, Yesilli C, Arikan N, Gogus O. Source: Urology. 2000 July; 56(1): 121-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10869639&dopt=Abstract

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Extraperitoneal laparoscopic hernia repair with local anesthesia. Author(s): Edelman DS, Misiakos EP, Moses K. Source: Surgical Endoscopy. 2001 September; 15(9): 976-80. Epub 2001 June 12. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11443449&dopt=Abstract

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False-positive Ga-67 citrate scan secondary to an inguinal hernia. Author(s): Fong W, Lim E. Source: Clinical Nuclear Medicine. 2002 July; 27(7): 534-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12072788&dopt=Abstract

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Familial bilateral congenital diaphragmatic hernia. Author(s): Kufeji DI, Crabbe DC. Source: Pediatric Surgery International. 1999; 15(1): 58-60. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9914358&dopt=Abstract

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Familial congenital diaphragmatic hernia: is an imprinting mechanism involved? Author(s): Austin-Ward ED, Taucher SC. Source: Journal of Medical Genetics. 1999 July; 36(7): 578-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10424826&dopt=Abstract

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Familial hiatal hernia and gastro-oesophageal reflux disease. Author(s): Coelho J, Sousa GS, Vianna RM. Source: The European Journal of Surgery = Acta Chirurgica. 1999 April; 165(4): 392-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10365844&dopt=Abstract

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Familial hiatal hernia in a large five generation family confirming true autosomal dominant inheritance. Author(s): Carre IJ, Johnston BT, Thomas PS, Morrison PJ. Source: Gut. 1999 November; 45(5): 649-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10517898&dopt=Abstract

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Fatal cardiac tamponade after emergency tension-free repair of a large paraesophageal hernia. Author(s): Kemppainen E, Kiviluoto T. Source: Surgical Endoscopy. 2000 June; 14(6): 593. Epub 2000 May 08. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11265062&dopt=Abstract

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Feasibility of local infiltration anaesthesia for recurrent groin hernia repair. Author(s): Callesen T, Bech K, Kehlet H. Source: The European Journal of Surgery = Acta Chirurgica. 2001 November; 167(11): 851-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11848240&dopt=Abstract

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Femoral hernia in children. Author(s): Al-Shanafey S, Giacomantonio M. Source: Journal of Pediatric Surgery. 1999 July; 34(7): 1104-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10442600&dopt=Abstract

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Femoral hernia in children. Author(s): Gul Y. Source: Ir Med J. 2000 September; 93(6): 183-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11105444&dopt=Abstract

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Femoral hernia repair with mesh-plug in children. Author(s): Ceran C, Koyluoglu G, Sonmez K. Source: Journal of Pediatric Surgery. 2002 October; 37(10): 1456-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12378453&dopt=Abstract

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Femoral hernia repair. Author(s): Hachisuka T. Source: The Surgical Clinics of North America. 2003 October; 83(5): 1189-205. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14533910&dopt=Abstract

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Fetal diaphragmatic hernia and upper limb anomalies suggest Brachmann-de Lange syndrome. Author(s): Marino T, Wheeler PG, Simpson LL, Craigo SD, Bianchi DW. Source: Prenatal Diagnosis. 2002 February; 22(2): 144-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11857622&dopt=Abstract

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Fetal liver position and perinatal outcome for congenital diaphragmatic hernia. Author(s): Albanese CT, Lopoo J, Goldstein RB, Filly RA, Feldstein VA, Calen PW, Jennings RW, Farrell JA, Harrison MR. Source: Prenatal Diagnosis. 1998 November; 18(11): 1138-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9854721&dopt=Abstract

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Fetal lung volume measurement by magnetic resonance imaging in congenital diaphragmatic hernia. Author(s): Mahieu-Caputo D, Sonigo P, Dommergues M, Fournet JC, Thalabard JC, Abarca C, Benachi A, Brunelle F, Dumez Y. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2001 August; 108(8): 863-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11510714&dopt=Abstract

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Fetal pulmonary artery diameters and their association with lung hypoplasia and postnatal outcome in congenital diaphragmatic hernia. Author(s): Sokol J, Bohn D, Lacro RV, Ryan G, Stephens D, Rabinovitch M, Smallhorn J, Hornberger LK. Source: American Journal of Obstetrics and Gynecology. 2002 May; 186(5): 1085-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12015541&dopt=Abstract

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Fetal stabilization for antenatally diagnosed diaphragmatic hernia. Author(s): Suita S, Taguchi T, Yamanouchi T, Masumoto K, Ogita K, Nakamura M, Nakayama H, Hara T, Tsukimori K, Nakano H, Kanna T, Takahashi S. Source: Journal of Pediatric Surgery. 1999 November; 34(11): 1652-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10591563&dopt=Abstract

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Fetoscopic temporary tracheal occlusion by means of detachable balloon for congenital diaphragmatic hernia. Author(s): Harrison MR, Albanese CT, Hawgood SB, Farmer DL, Farrell JA, Sandberg PL, Filly RA. Source: American Journal of Obstetrics and Gynecology. 2001 September; 185(3): 730-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11568805&dopt=Abstract

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Fetoscopic temporary tracheal occlusion for congenital diaphragmatic hernia: prelude to a randomized, controlled trial. Author(s): Harrison MR, Sydorak RM, Farrell JA, Kitterman JA, Filly RA, Albanese CT. Source: Journal of Pediatric Surgery. 2003 July; 38(7): 1012-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12861529&dopt=Abstract

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First aid treatment of critically acute epidural hematoma complicated by cerebra l hernia using cranial trepanation and drainage decompression: a report of 16 cases. Author(s): Chen N. Source: Chinese Journal of Traumatology = Chung-Hua Ch'uang Shang Tsa Chih / Chinese Medical Association. 2002 February; 5(1): 62-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11835762&dopt=Abstract

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First Hungarian, internet-based prospective, multicenter study: the hernia-project. Author(s): Weber G, Kassai M, Csontos Z, Czuczor C, Horvath PO. Source: Acta Chir Hung. 1999; 38(2): 219-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10596334&dopt=Abstract

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First operative series that documented and used posterior gastric fixation for the surgical correction of hiatus hernia and gastroesophageal reflux. Author(s): Bennet JM. Source: Annals of Surgery. 2001 September; 234(3): 425. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11583006&dopt=Abstract

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Five-year experience with the “four-before” laparoscopic ventral hernia repair. Author(s): Reitter DR, Paulsen JK, Debord JR, Estes NC. Source: The American Surgeon. 2000 May; 66(5): 465-8; Discussion 468-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10824747&dopt=Abstract

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Five-year follow-up of patients undergoing laparoscopic or open groin hernia repair: a randomized controlled trial. Author(s): Wright D, Paterson C, Scott N, Hair A, O'Dwyer PJ. Source: Annals of Surgery. 2002 March; 235(3): 333-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11882754&dopt=Abstract

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Focal testicular infarction from laparoscopic inguinal hernia repair. Author(s): Mincheff T, Bannister B, Zubel P. Source: Jsls. 2002 July-September; 6(3): 211-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12166758&dopt=Abstract

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Foramen of Morgagni hernia: surgical consideration. Author(s): Meredith K, Allen J, Richardson JD, Bergamini TM. Source: J Ky Med Assoc. 2000 July; 98(7): 286-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10918753&dopt=Abstract

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From androlog. Potential for vasal occlusion among men after hernia repair using mesh. Author(s): Meacham RB. Source: Journal of Andrology. 2002 November-December; 23(6): 759-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12399520&dopt=Abstract

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Fryns syndrome in children with congenital diaphragmatic hernia. Author(s): Neville HL, Jaksic T, Wilson JM, Lally PA, Hardin WD Jr, Hirschl RB, Langham MR Jr, Lally KP; Congenital Diaphragmatic Hernia Study Group. Source: Journal of Pediatric Surgery. 2002 December; 37(12): 1685-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12483630&dopt=Abstract

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Functional and morphological evaluation of a low-weight, monofilament polypropylene mesh for hernia repair. Author(s): Klinge U, Junge K, Stumpf M, AP AP, Klosterhalfen B. Source: Journal of Biomedical Materials Research. 2002; 63(2): 129-36. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11870645&dopt=Abstract

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Functional impairment and complaints following incisional hernia repair with different polypropylene meshes. Author(s): Welty G, Klinge U, Klosterhalfen B, Kasperk R, Schumpelick V. Source: Hernia : the Journal of Hernias and Abdominal Wall Surgery. 2001 September; 5(3): 142-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11759800&dopt=Abstract

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Fusion of childhood inguinal hernia induced by HGF and CGRP via an epithelial transition. Author(s): Cook BJ, Hasthorpe S, Hutson JM. Source: Journal of Pediatric Surgery. 2000 January; 35(1): 77-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10646779&dopt=Abstract

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Future of laparoscopic inguinal hernia surgery. Author(s): Beattie DK, Foley RJ, Callam MJ. Source: The British Journal of Surgery. 2000 December; 87(12): 1727-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11122193&dopt=Abstract

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G. Buchanan on inguinal hernia treatment: a review 111-years after. Author(s): Etker S. Source: Pediatr Cerrahi Derg. 1990; 4: 136-38. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11639915&dopt=Abstract

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Ga-67 accumulation in inguinal hernia mimicking lymph nodes in non-Hodgkin's lymphoma. Author(s): Berk F, Demir H, Erdincler O, Isgoren S, Aktolun C. Source: Clinical Nuclear Medicine. 2002 January; 27(1): 65-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11805495&dopt=Abstract

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Gallstone in a hernia sac. Author(s): Aspelund G, Halldorsdottir BA, Isaksson HJ, Moller PH. Source: Surgical Endoscopy. 2003 April; 17(4): 657. Epub 2003 February 17. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12582777&dopt=Abstract

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Gangrenous appendicitis in a strangulated obturator hernia. Author(s): Kjossev KT, Losanoff JE. Source: Southern Medical Journal. 2003 October; 96(10): 1042-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14570354&dopt=Abstract

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Gangrenous intestine in a hernia can be reduced. Author(s): Strauch ED, Voigt RW, Hill JL. Source: Journal of Pediatric Surgery. 2002 June; 37(6): 919-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12037764&dopt=Abstract

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Gangrenous Richter's hernia with intrasac abscess. Author(s): Bhattacharya K, Ramakrishnan R, Gopalan TR. Source: Trop Gastroenterol. 2002 October-December; 23(4): 195. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12833711&dopt=Abstract

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Gas extravasation complicating laparoscopic extraperitoneal inguinal hernia repair. Author(s): Hagopian EJ, Steichen FM, Lee KF, Earle DB. Source: Surgical Endoscopy. 2001 March; 15(3): 324. Epub 2001 February 06. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11344443&dopt=Abstract

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Gas-filled umbilical hernia (Pneumo-umbilicus). A CT sign of hypertensive pneumoperitoneum. Author(s): Catalano O, Esposito M, Siani A. Source: Rofo. Fortschritte Auf Dem Gebiete Der Rontgenstrahlen Und Der Neuen Bildgebenden Verfahren. 2001 December; 173(12): 1150-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11740679&dopt=Abstract

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Gastric and omental incarceration through an occult traumatic diaphragmatic hernia in a scuba diver. Author(s): Chanson C, Hahnloser D, Nassiopoulos K, Petropoulos P. Source: The Journal of Trauma. 2002 January; 52(1): 146-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11791065&dopt=Abstract

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Gastric hemorrhage and ulceration in hiatal hernia sac associated with alendronate. Author(s): Kaye PS. Source: Digestive Diseases and Sciences. 1999 May; 44(5): 903-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10235594&dopt=Abstract

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Gastric incarceration and perforation following posttraumatic diaphragmatic hernia. Author(s): Prieto Nieto I, Perez Robledo JP, Rosales Trelles V, De Miguel Ibanez R, Fernandez Prieto A, Calvo Celada A. Source: Acta Chir Belg. 2001 March-April; 101(2): 81-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11396058&dopt=Abstract

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Gastric volvulus associated with congenital diaphragmatic hernia, wandering spleen, and intrathoracic left kidney: CT findings. Author(s): Pelizzo G, Lembo MA, Franchella A, Giombi A, D'Agostino F, Sala S. Source: Abdominal Imaging. 2001 May-June; 26(3): 306-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11429960&dopt=Abstract

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Gastroduodenal ulcer perforating in epigastric hernia. Author(s): Coulier B, Cloots V, Maldague P, Broze B. Source: Jbr-Btr. 2002 October-November; 85(5): 264. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12463504&dopt=Abstract

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Gastroesophageal reflux after repair of congenital diaphragmatic hernia. Author(s): Kamiyama M, Kawahara H, Okuyama H, Oue T, Kuroda S, Kubota A, Okada A. Source: Journal of Pediatric Surgery. 2002 December; 37(12): 1681-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12483629&dopt=Abstract

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Gastroesophageal reflux and diaphragmatic motility after repair of congenital diaphragmatic hernia. Author(s): Fasching G, Huber A, Uray E, Sorantin E, Lindbichler F, Mayr J. Source: European Journal of Pediatric Surgery : Official Journal of Austrian Association of Pediatric Surgery. [et Al] = Zeitschrift Fur Kinderchirurgie. 2000 December; 10(6): 3604. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11215775&dopt=Abstract

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Gastrointestinal/genitourinary case of the day. Incarcerated inguinal hernia of the left fallopian tube and ovary. Author(s): Roth CG, Varma JD, Tello R. Source: Ajr. American Journal of Roentgenology. 1999 September; 173(3): 787, 791-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10470925&dopt=Abstract

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Gastrointestinal: diaphragmatic hernia. Author(s): Groneberg DA, Tai YF, Almari AF, Pereira JH. Source: Journal of Gastroenterology and Hepatology. 2001 November; 16(11): 1305. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11903752&dopt=Abstract

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Giant congenital epigastric hernia. Author(s): Ameh EA. Source: West Afr J Med. 1999 April-June; 18(2): 151-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10504877&dopt=Abstract

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Giant gastrointestinal stromal tumor, associated with esophageal hiatus hernia. Author(s): Miyauchi T, Ishikawa M, Nisioka M, Kashiwagi Y, Miki H, Sato Y, Endo N, Uemura T, Inoue S, Hiroi M, Kikutsuji T, Ohgami N. Source: J Med Invest. 2002 August; 49(3-4): 186-92. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12323009&dopt=Abstract

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Giant hiatal hernia presenting with stable angina pectoris and syncope--a case report. Author(s): Akdemir I, Davutoglu V, Aktaran S. Source: Angiology. 2001 December; 52(12): 863-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11775629&dopt=Abstract

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Giant paratesticular undifferentiated liposarcoma that developed in a long-standing inguinal hernia. Author(s): Cariati A, Brignole E, Tonelli E, Filippi M. Source: The European Journal of Surgery = Acta Chirurgica. 2002; 168(8-9): 511-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12549695&dopt=Abstract

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Giant prosthetic reinforcement of the visceral sac. The Stoppa groin hernia repair. Author(s): Wantz GE. Source: The Surgical Clinics of North America. 1998 December; 78(6): 1075-87. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9927985&dopt=Abstract

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Glandular inclusions in inguinal hernia sacs: morphologic and immunohistochemical distinction from epididymis and vas deferens. Author(s): Cerilli LA, Sotelo-Avila C, Mills SE. Source: The American Journal of Surgical Pathology. 2003 April; 27(4): 469-76. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12657931&dopt=Abstract

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Glucocorticoid receptor gene expression in the hypoplastic lung of newborns with congenital diaphragmatic hernia. Author(s): Solari V, Puri P. Source: Journal of Pediatric Surgery. 2002 May; 37(5): 715-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11987085&dopt=Abstract

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Gravid uterus in an incisional hernia. Author(s): Banerjee N, Deka D, Sinha A, Prasrad R, Takkar D. Source: The Journal of Obstetrics and Gynaecology Research. 2001 April; 27(2): 77-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11396642&dopt=Abstract

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Groin hernia and surgical truth. Author(s): McGreevy JM. Source: American Journal of Surgery. 1998 October; 176(4): 301-4. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9817243&dopt=Abstract

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Groin hernia repair in Scotland. Author(s): Hair A, Duffy K, McLean J, Taylor S, Smith H, Walker A, MacIntyre IM, O'Dwyer PJ. Source: The British Journal of Surgery. 2000 December; 87(12): 1722-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11122192&dopt=Abstract

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Groin hernia surgery: a systematic review. Author(s): Cheek CM, Black NA, Devlin HB, Kingsnorth AN, Taylor RS, Watkin DF. Source: Annals of the Royal College of Surgeons of England. 1998; 80 Suppl 1: S1-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11432408&dopt=Abstract

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Groin hernia surgery: a systematic review. Author(s): Mann A. Source: Annals of the Royal College of Surgeons of England. 1999 January; 81(1): 69-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10325692&dopt=Abstract

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Groin pain after hernia repair. Author(s): Condon RE. Source: Annals of Surgery. 2001 January; 233(1): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11141217&dopt=Abstract

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Groin pain in the absence of hernia: a new syndrome. Author(s): Deysine M, Deysine GR, Reed WP Jr. Source: Hernia : the Journal of Hernias and Abdominal Wall Surgery. 2002 July; 6(2): 647. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12152641&dopt=Abstract

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Guide to hernia repair. Strain of thought. Author(s): Bryan J. Source: Health Serv J. 1999 January 28; 109(5639): Suppl 12-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10345645&dopt=Abstract

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Guidelines for inguinal hernia repair in everyday practice. Author(s): Metzger J, Lutz N, Laidlaw I. Source: Annals of the Royal College of Surgeons of England. 2001 May; 83(3): 209-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11432143&dopt=Abstract

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Half-Fourier acquisition single-shot turbo spin echo imaging in the diagnosis of Morgagni hernia. Author(s): Tyrell D, Mohamed F, Pavlides C, Kutalek S, Mulhern C, Nunes LW. Source: Journal of Magnetic Resonance Imaging : Jmri. 2001 November; 14(5): 653-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11747019&dopt=Abstract

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Handlebar hernia masquerading as an inguinal haematoma. Author(s): Fraser N, Milligan S, Arthur RJ, Crabbe DC. Source: Hernia : the Journal of Hernias and Abdominal Wall Surgery. 2002 March; 6(1): 39-41. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12090581&dopt=Abstract

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Handlebar hernia: case report and review of pediatric cases. Author(s): Kubota A, Shono J, Yonekura T, Hoki M, Asano S, Hirooka S, Kosumi T, Kato M, Oyanagi H. Source: Pediatric Surgery International. 1999 July; 15(5-6): 411-2. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10415303&dopt=Abstract

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Handlebar hernia: ultrasonography-aided diagnosis. Author(s): Losanoff JE, Richman BW, Jones JW. Source: Hernia : the Journal of Hernias and Abdominal Wall Surgery. 2002 March; 6(1): 36-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12090580&dopt=Abstract

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Have outcomes of incisional hernia repair improved with time? A population-based analysis. Author(s): Flum DR, Horvath K, Koepsell T. Source: Annals of Surgery. 2003 January; 237(1): 129-35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12496540&dopt=Abstract

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Hearing loss in infants with congenital diaphragmatic hernia treated without extracorporeal membrane oxygenation: report of two cases. Author(s): Kuga T, Taniguchi S, Inoue T, Zempo N, Esato K. Source: Journal of Pediatric Surgery. 2000 April; 35(4): 621-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10770399&dopt=Abstract

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Helicobacter pylori infection and hiatal hernia do not affect acid reflux and esophageal motility in patients with gastro-esophageal reflux. Author(s): Awad RA, Camacho S. Source: Journal of Gastroenterology. 2002; 37(4): 247-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11993507&dopt=Abstract

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Hernia audit in private practice. Author(s): Kark AE, Kurzer M, Belsham P. Source: Journal of the Royal Society of Medicine. 1999 February; 92(2): 102-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10450233&dopt=Abstract

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Hernia clinic in a teaching institution: creation and development. Author(s): Deysine M. Source: Hernia : the Journal of Hernias and Abdominal Wall Surgery. 2001 June; 5(2): 659. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11505650&dopt=Abstract

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Hernia of foramen of Morgagni in adult: case report of laparoscopic repair. Author(s): Angrisani L, Lorenzo M, Santoro T, Sodano A, Tesauro B. Source: Jsls. 2000 April-June; 4(2): 177-81. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10917128&dopt=Abstract

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Hernia of right colon and cecum through the foramen of Winslow and lesser omentum. Author(s): Rich PB, Burke L, Cairns BA. Source: Journal of the American College of Surgeons. 2002 February; 194(2): 230. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11848639&dopt=Abstract

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Hernia of the lung. Author(s): Weissberg D, Refaely Y. Source: The Annals of Thoracic Surgery. 2002 December; 74(6): 1963-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12643381&dopt=Abstract

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Hernia of the posterior lamina of the rectus abdominis muscle sheath: report of a case. Author(s): Gangi S, Sparacino T, Furci M, Basile F. Source: Ann Ital Chir. 2002 May-June; 73(3): 335-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12404903&dopt=Abstract

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Hernia repair during endoscopic (laparoscopic) radical prostatectomy. Author(s): Stolzenburg JU, Rabenalt R, Dietel A, Do M, Pfeiffer H, Schwalbe S, Dorschner W. Source: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A. 2003 February; 13(1): 27-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12676018&dopt=Abstract

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Hernia surgery in the mid 19th century. Author(s): Rutkow IM. Source: Archives of Surgery (Chicago, Ill. : 1960). 2002 August; 137(8): 973-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12147003&dopt=Abstract

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Hernia surgery, anesthetic technique, and urinary retention-apples, oranges, and kumquats? Author(s): Mulroy MF. Source: Regional Anesthesia and Pain Medicine. 2002 November-December; 27(6): 587-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12430109&dopt=Abstract

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Hernia through an iliac crest bone-graft donor site. Author(s): Danikas D, Theodorou SJ, Stratoulias C, Constantinopoulos G, Ginalis EM. Source: Plastic and Reconstructive Surgery. 2002 November; 110(6): 1612-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12409803&dopt=Abstract

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Hernioplasty and simultaneous laparoscopic cholecystectomy: a prospective randomized study of open tension-free versus laparoscopic inguinal hernia repair. Author(s): Sarli L, Villa F, Marchesi F. Source: Surgery. 2001 May; 129(5): 530-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11331444&dopt=Abstract

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Hiatal hernia and acid reflux frequency predict presence and length of Barrett's esophagus. Author(s): Avidan B, Sonnenberg A, Schnell TG, Sontag SJ. Source: Digestive Diseases and Sciences. 2002 February; 47(2): 256-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11855539&dopt=Abstract

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Hiatal hernia controversies--a review of pathophysiology and treatment options. Author(s): Sivacolundhu RK, Read RA, Marchevsky AM. Source: Aust Vet J. 2002 January-February; 80(1-2): 48-53. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12180879&dopt=Abstract

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Hiatal hernia in pediatric gastroesophageal reflux. Author(s): Gorenstein A, Cohen AJ, Cordova Z, Witzling M, Krutman B, Serour F. Source: Journal of Pediatric Gastroenterology and Nutrition. 2001 November; 33(5): 5547. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11740228&dopt=Abstract

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Hiatal hernia is the key factor determining the lansoprazole dosage required for effective intra-oesophageal acid suppression. Author(s): Frazzoni M, De Micheli E, Grisendi A, Savarino V. Source: Alimentary Pharmacology & Therapeutics. 2002 May; 16(5): 881-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11966495&dopt=Abstract

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Hiatal hernia masquerading as an extracardiac mass on transesophageal echocardiogram. Author(s): Gupta R, Chamoun A, Ahmad M, Birnbaum Y. Source: Clin Cardiol. 2003 July; 26(7): 353. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12862304&dopt=Abstract

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Hiatal hernia mimics centrally necrotic cancer in the lung on FDG positron emission tomographic imaging. Author(s): Bhargava P, Zhuang H, Alavi A. Source: Clinical Nuclear Medicine. 2003 April; 28(4): 347-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12642727&dopt=Abstract

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Hiatal hernia size is the dominant determinant of esophagitis presence and severity in gastroesophageal reflux disease. Author(s): Jones MP, Sloan SS, Rabine JC, Ebert CC, Huang CF, Kahrilas PJ. Source: The American Journal of Gastroenterology. 2001 June; 96(6): 1711-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11419819&dopt=Abstract

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Hiatal hernia size, Barrett's length, and severity of acid reflux are all risk factors for esophageal adenocarcinoma. Author(s): Avidan B, Sonnenberg A, Schnell TG, Chejfec G, Metz A, Sontag SJ. Source: The American Journal of Gastroenterology. 2002 August; 97(8): 1930-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12190156&dopt=Abstract

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Hiatal hernia with pancreatic volvulus: a rare cause of acute pancreatitis. Author(s): Chevallier P, Peten E, Pellegrino C, Souci J, Motamedi JP, Padovani B. Source: Ajr. American Journal of Roentgenology. 2001 August; 177(2): 373-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11461866&dopt=Abstract

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Hiatal hernia, reflux symptoms, body size, and risk of esophageal and gastric adenocarcinoma. Author(s): Wu AH, Tseng CC, Bernstein L. Source: Cancer. 2003 September 1; 98(5): 940-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12942560&dopt=Abstract

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Hiatal hernia. Author(s): Belafsky PC, Postma GN, Koufman JA. Source: Ear, Nose, & Throat Journal. 2002 August; 81(8): 502. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12199165&dopt=Abstract

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Hiatus hernia and intrathoracic migration of esophagogastric junction in gastroesophageal reflux disease. Author(s): Mattioli S, D'Ovidio F, Pilotti V, Di Simone MP, Lugaresi ML, Bassi F, Brusori S. Source: Digestive Diseases and Sciences. 2003 September; 48(9): 1823-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14561009&dopt=Abstract

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High frequency oscillatory ventilation during repair of neonatal congenital diaphragmatic hernia. Author(s): Bouchut JC, Dubois R, Moussa M, Godard J, Picaud JC, Di Maio M, Claris O, Bouletreau P. Source: Paediatric Anaesthesia. 2000; 10(4): 377-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10886693&dopt=Abstract

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High incidence of reflux oesophagitis after eradication therapy for Helicobacter pylori: impacts of hiatal hernia and corpus gastritis. Author(s): Hamada H, Haruma K, Mihara M, Kamada T, Yoshihara M, Sumii K, Kajiyama G, Kawanishi M. Source: Alimentary Pharmacology & Therapeutics. 2000 June; 14(6): 729-35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10848656&dopt=Abstract

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High recurrence rate 12 years after primary inguinal hernia repair. Author(s): Melis P, van der Drift DG, Sybrandy R, Go PM. Source: The European Journal of Surgery = Acta Chirurgica. 2000 April; 166(4): 313-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10817329&dopt=Abstract

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High-frequency oscillatory ventilation versus conventional mechanical ventilation in congenital diaphragmatic hernia. Author(s): Cacciari A, Ruggeri G, Mordenti M, Ceccarelli PL, Baccarini E, Pigna A, Gentili A. Source: European Journal of Pediatric Surgery : Official Journal of Austrian Association of Pediatric Surgery. [et Al] = Zeitschrift Fur Kinderchirurgie. 2001 February; 11(1): 3-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11370980&dopt=Abstract

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Hindbrain hernia masquerading as postpartum subarachnoid haemorrhage. Author(s): Wynne-Jones GA, Akinwunmi J, Flint G. Source: British Journal of Neurosurgery. 2003 February; 17(1): 78-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12779208&dopt=Abstract

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History of treatment of groin hernia. Author(s): Lau WY. Source: World Journal of Surgery. 2002 June; 26(6): 748-59. Epub 2002 March 26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12053232&dopt=Abstract

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Hormonal modulation of fetal pulmonary development: relevance for the fetus with diaphragmatic hernia. Author(s): Keijzer R, van Tuyl M, Tibboel D. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2000 September; 92(1): 127-33. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10986446&dopt=Abstract

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Hospitalization with respiratory disease following hiatal hernia and reflux esophagitis in a prospective, population-based study. Author(s): Ruhl CE, Sonnenberg A, Everhart JE. Source: Annals of Epidemiology. 2001 October; 11(7): 477-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11557179&dopt=Abstract

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How to repair an adult indirect inguinal hernia? Author(s): Beets GL. Source: The European Journal of Surgery = Acta Chirurgica. 2000 April; 166(4): 348. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10817336&dopt=Abstract

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Hunterian lecture. Laparoscopic transabdominal pre-peritoneal (TAPP) repair of groin hernia: one surgeon's experience of a developing technique. Author(s): Evans DS. Source: Annals of the Royal College of Surgeons of England. 2002 November; 84(6): 3938. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12484578&dopt=Abstract

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Iatrogenic intrapericardial diaphragmatic hernia. Author(s): Chin RY, Glew MJ, Brady P. Source: Anz Journal of Surgery. 2002 September; 72(9): 681-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12269926&dopt=Abstract

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Iliac arterial thrombosis after inguinal hernia repair. Author(s): Van Buren SF, Heit JA, Panneton JM, Donohue JH. Source: Mayo Clinic Proceedings. 2002 December; 77(12): 1361-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12479526&dopt=Abstract

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Image of the month. Foramen of Winslow hernia. Author(s): Stahlfeld KR, Edwards M, Sell HW. Source: Archives of Surgery (Chicago, Ill. : 1960). 2003 May; 138(5): 561-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12742963&dopt=Abstract

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Impaired structural remodelling of pulmonary arteries in newborns with congenital diaphragmatic hernia: a histological study of 29 cases. Author(s): Shehata SM, Tibboel D, Sharma HS, Mooi WJ. Source: The Journal of Pathology. 1999 September; 189(1): 112-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10451497&dopt=Abstract

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Incarceration of umbilical hernia in children: is the trend increasing? Author(s): Keshtgar AS, Griffiths M. Source: European Journal of Pediatric Surgery : Official Journal of Austrian Association of Pediatric Surgery. [et Al] = Zeitschrift Fur Kinderchirurgie. 2003 February; 13(1): 40-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12664414&dopt=Abstract

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Incidence and aetiological factors of incisional hernia in post-caesarean operations in a Nigerian hospital. Author(s): Adesunkanmi AR, Faleyimu B. Source: Journal of Obstetrics and Gynaecology : the Journal of the Institute of Obstetrics and Gynaecology. 2003 May; 23(3): 258-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12850855&dopt=Abstract

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Incisional bladder hernia after rectus fascial sling. Author(s): Gomelsky A, Dmochowski RR. Source: The Journal of Urology. 2003 June; 169(6): 2299. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12771778&dopt=Abstract

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Incisional hernia after suprapubic catheter insertion. Author(s): Mehta A, Makris A, Saad A, Callaghan PS. Source: Bju International. 1999 September; 84(4): 526-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10468775&dopt=Abstract

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Incisional hernia after suprapubic trocar cystostomy. Author(s): Nabi G, Aron M, Gupta NP. Source: Urologia Internationalis. 2003; 70(3): 249-50. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12660470&dopt=Abstract

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Incisional hernia following orthotopic liver transplantation. Author(s): Shi LW, Verran D, Rao AR, Stewart GJ, McCaughan GW. Source: Transplantation Proceedings. 2003 February; 35(1): 425-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12591471&dopt=Abstract

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Incisional hernia repair. Author(s): Millikan KW. Source: The Surgical Clinics of North America. 2003 October; 83(5): 1223-34. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14533912&dopt=Abstract

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Incisional hernia treatment with progressive pneumoperitoneum and retromuscular prosthetic hernioplasty. Author(s): Toniato A, Pagetta C, Bernante P, Piotto A, Pelizzo MR. Source: Langenbeck's Archives of Surgery / Deutsche Gesellschaft Fur Chirurgie. 2002 October; 387(5-6): 246-8. Epub 2002 September 26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12410362&dopt=Abstract

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Influence of suture material and surgical technique on risk of reoperation after nonmesh open hernia repair. Author(s): Nordin P, Haapaniemi S, Kald A, Nilsson E. Source: The British Journal of Surgery. 2003 August; 90(8): 1004-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12905556&dopt=Abstract

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Inguinal hernia after laparoscopic orchiopexy. Author(s): Metwalli AR, Cheng EY. Source: The Journal of Urology. 2002 November; 168(5): 2163. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12394749&dopt=Abstract

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Inguinal hernia in the male child: where the latest skirmish line has formed. Author(s): Dehner LP. Source: The American Journal of Surgical Pathology. 1999 August; 23(8): 869-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10435553&dopt=Abstract

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Inguinal hernia in the premature infant: management of a common problem. Author(s): Burd AJ, Burd RS. Source: Neonatal Netw. 2002 November-December; 21(7): 39-44; Quiz 45-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12514988&dopt=Abstract

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Inguinal hernia repair: where to next? Author(s): Amid PK. Source: Anz Journal of Surgery. 2003 May; 73(5): 352; Author Reply 352-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12752296&dopt=Abstract

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Inguinal hernia. Author(s): Maisonet L. Source: Pediatrics in Review / American Academy of Pediatrics. 2003 January; 24(1): 345. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12509545&dopt=Abstract

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Inguinal hernia: obligatory indication for elective surgery? A prospective assessment of quality of life before and after plug and patch inguinal hernia repair. Author(s): Zieren J, Kupper F, Paul M, Neuss H, Muller JM. Source: Langenbeck's Archives of Surgery / Deutsche Gesellschaft Fur Chirurgie. 2003 February; 387(11-12): 417-20. Epub 2003 January 11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12607122&dopt=Abstract

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Inguinal hernioplasty: the gold standard of hernia repair. Author(s): Forte A, D'Urso A, Palumbo P, Lo Storto G, Gallinaro LS, Bezzi M, Beltrami V. Source: Hernia : the Journal of Hernias and Abdominal Wall Surgery. 2003 March; 7(1): 35-8. Epub 2002 December 17. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12612796&dopt=Abstract

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Intercostodiaphragmatic hernia secondary to a bull gore injury: a delayed detection. Author(s): Nabi G, Seenu V, Misra MC. Source: Indian J Chest Dis Allied Sci. 2002 July-September; 44(3): 187-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12206479&dopt=Abstract

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Internal hernia of the small bowel around infrarenal arterial conduits after liver transplantation. Author(s): Nishida S, Pinna AG, Nery JR, Levi D, Kato T, Madariaga J, Tzakis AG. Source: Clinical Transplantation. 2002 October; 16(5): 334-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12225429&dopt=Abstract

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Internal hernia presenting as obstructive jaundice and acute pancreatitis. Author(s): Joo YE, Kim HS, Choi SK, Rew JS, Kim HR, Cho CK, Kim SJ. Source: Scandinavian Journal of Gastroenterology. 2002 August; 37(8): 983-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12229977&dopt=Abstract

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Internal hernia presenting as obstructive jaundice. Author(s): Losanoff JE, Richman BW, Jones JW. Source: Scandinavian Journal of Gastroenterology. 2003 January; 38(1): 123. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12608475&dopt=Abstract

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Intestinal occlusion and spigelian hernia. Author(s): Benito MP, Valderrama JE, Gonzalez FJ, Muniain JM. Source: Journal of Clinical Gastroenterology. 1999 September; 29(2): 213-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10478894&dopt=Abstract

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Intraperitoneal underlay ventral hernia repair utilizing bilayer expanded polytetrafluoroethylene and polypropylene mesh. Author(s): Millikan KW, Baptista M, Amin B, Deziel DJ, Doolas A. Source: The American Surgeon. 2003 April; 69(4): 287-91; Discussion 291-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12716085&dopt=Abstract

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Intrascrotal hernia of the ureter and fatty hernia. Author(s): Giuly J, Francois GF, Giuly D, Leroux C, Nguyen-Cat RR. Source: Hernia : the Journal of Hernias and Abdominal Wall Surgery. 2003 March; 7(1): 47-9. Epub 2002 November 01. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12612799&dopt=Abstract

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Introduction: inguinal hernia management-testing management strategies in two clinical trials. Author(s): Jonasson O. Source: Journal of the American College of Surgeons. 2003 May; 196(5): 735-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12742206&dopt=Abstract

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Is laparoscopic umbilical hernia repair with mesh a reasonable alternative to conventional repair? Author(s): Wright BE, Beckerman J, Cohen M, Cumming JK, Rodriguez JL. Source: American Journal of Surgery. 2002 December; 184(6): 505-8; Discussion 508-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12488148&dopt=Abstract

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Is parastomal hernia repair with polypropylene mesh safe? Author(s): Steele SR, Lee P, Martin MJ, Mullenix PS, Sullivan ES. Source: American Journal of Surgery. 2003 May; 185(5): 436-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12727563&dopt=Abstract

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Is prosthetic umbilical hernia repair bound to replace primary herniorrhaphy in the adult patient? Author(s): Arroyo Sebastian A, Perez F, Serrano P, Costa D, Oliver I, Ferrer R, Lacueva J, Calpena R. Source: Hernia : the Journal of Hernias and Abdominal Wall Surgery. 2002 December; 6(4): 175-7. Epub 2002 October 19. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12424596&dopt=Abstract

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Laparoscopic evaluation in incarcerated groin hernia following spontaneous reduction. Author(s): Guvenc BH, Tugay M. Source: Ulus Travma Derg. 2003 April; 9(2): 143-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12836114&dopt=Abstract

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Laparoscopic extraperitoneal inguinal hernia repair versus open mesh repair: a prospective randomized controlled trial. Author(s): Andersson B, Hallen M, Leveau P, Bergenfelz A, Westerdahl J. Source: Surgery. 2003 May; 133(5): 464-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12773973&dopt=Abstract

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Laparoscopic hernia repairs may make subsequent radical retropubic prostatectomy more hazardous. Author(s): Cook H, Afzal N, Cornaby AJ. Source: Bju International. 2003 May; 91(7): 729. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12699496&dopt=Abstract

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Laparoscopic intraperitoneal repair of postoperative ventral incisional hernia using Composix mesh. Author(s): Araki Y, Ishibashi N, Kanazawa M, Kishimoto Y, Matono K, Sasatomi T, Ogata Y, Shirouzu K. Source: Kurume Med J. 2002; 49(4): 167-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12652966&dopt=Abstract

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Laparoscopic management of omental torsion secondary to an occult inguinal hernia. Author(s): Siu WT, Law BK, Tang CN, Chau CH, Li MK. Source: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A. 2003 June; 13(3): 199-201. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12855104&dopt=Abstract

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Laparoscopic paracecal hernia repair. Author(s): Omori H, Asahi H, Inoue Y, Irinoda T, Saito K. Source: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A. 2003 February; 13(1): 55-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12676024&dopt=Abstract

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Laparoscopic paraesophageal hernia repair, a challenging operation: medium-term outcome of 116 patients. Author(s): Diaz S, Brunt LM, Klingensmith ME, Frisella PM, Soper NJ. Source: Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract. 2003 January; 7(1): 59-66; Discussion 66-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12559186&dopt=Abstract

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Laparoscopic parastomal hernia repair. Author(s): Gould JC, Ellison EC. Source: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques. 2003 February; 13(1): 51-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12598761&dopt=Abstract

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Laparoscopic parastomal hernia repair. Author(s): Deol ZK, Shayani V. Source: Archives of Surgery (Chicago, Ill. : 1960). 2003 February; 138(2): 203-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12578421&dopt=Abstract

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Laparoscopic refundoplication with prosthetic hiatal closure for recurrent hiatal hernia after primary failed antireflux surgery. Author(s): Granderath FA, Kamolz T, Schweiger UM, Pointner R. Source: Archives of Surgery (Chicago, Ill. : 1960). 2003 August; 138(8): 902-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12912751&dopt=Abstract

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Laparoscopic repair of a recurrent chronic traumatic diaphragmatic hernia. Author(s): Frantzides CT, Madan AK, O'Leary PJ, Losurdo J. Source: The American Surgeon. 2003 February; 69(2): 160-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12641359&dopt=Abstract

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Laparoscopic repair of access port site hernia after Lap-Band system implantation. Author(s): Susmallian S, Ezri T, Charuzi I. Source: Obesity Surgery : the Official Journal of the American Society for Bariatric Surgery and of the Obesity Surgery Society of Australia and New Zealand. 2002 October; 12(5): 682-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12448392&dopt=Abstract

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Laparoscopic repair of an internal supravesical hernia: a rare hernia causing small bowel obstruction. Author(s): Gorgun E, Onur E, Baca B, Apaydin B, Yavuz N, Sirin F. Source: Surgical Endoscopy. 2003 April; 17(4): 659. Epub 2003 February 10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12574931&dopt=Abstract

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Laparoscopic repair of blunt traumatic anterior abdominal wall hernia. Author(s): Munshi IA, Ravi SP, Earle DB. Source: Jsls. 2002 October-December; 6(4): 385-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12500842&dopt=Abstract

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Laparoscopic repair of congenital diaphragmatic hernia with prosthesis: a case report. Author(s): Settembre A, Cuccurullo D, Pisaniello D, Capasso P, Miranda L, Corcione F. Source: Hernia : the Journal of Hernias and Abdominal Wall Surgery. 2003 March; 7(1): 52-4. Epub 2002 November 30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12612801&dopt=Abstract

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Laparoscopic repair of diaphragmatic hernia after left ventricular assist device. Author(s): Farma J, Leeser D, Furukawa S, Dempsey DT. Source: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A. 2003 June; 13(3): 185-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12855101&dopt=Abstract

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Laparoscopic repair of diaphragmatic Morgagni hernia. Author(s): de Vogelaere K, de Backer A, Delvaux G. Source: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A. 2002 December; 12(6): 457-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12590730&dopt=Abstract

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Laparoscopic repair of Morgagni hernia and paraesophageal hernia on the same patient. Author(s): Cokmez A, Durak E. Source: Surgical Endoscopy. 2003 April; 17(4): 660. Epub 2003 February 10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12574935&dopt=Abstract

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Laparoscopically assisted approach for postoperative ventral hernia repair. Author(s): Eitan A, Bickel A. Source: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A. 2002 October; 12(5): 309-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12470403&dopt=Abstract

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Large hiatus hernia compressing the heart and impairing the respiratory function. Author(s): Ueda T, Mizushige K. Source: J Cardiol. 2003 April; 41(4): 211; Author Reply 211-2. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12728542&dopt=Abstract

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Late fascial closure in lieu of ventral hernia: the next step in open abdomen management. Author(s): Miller PR, Thompson JT, Faler BJ, Meredith JW, Chang MC. Source: The Journal of Trauma. 2002 November; 53(5): 843-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12435933&dopt=Abstract

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Late presentation of Bochdalek hernia with intestinal symptoms. Author(s): Burki T, Amanullah A, Rehman AU, Ali MN. Source: J Ayub Med Coll Abbottabad. 2002 July-September; 14(3): 27-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12476861&dopt=Abstract

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Lateral cutaneous nerve of the thigh pain in association with inguinal hernia repair. Author(s): Davies RG, Arthurs G. Source: Anaesthesia. 2003 May; 58(5): 489-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12694017&dopt=Abstract

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Left diaphragmatic eventration diagnosed as congenital diaphragmatic hernia by prenatal sonography. Author(s): Yang JI. Source: Journal of Clinical Ultrasound : Jcu. 2003 May; 31(4): 214-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12692831&dopt=Abstract

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Lessons learned from ligation of indirect hernia sac: an alternative to reduction during endoscopic extraperitoneal inguinal hernioplasty. Author(s): Lau H, Lee F. Source: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A. 2002 December; 12(6): 419-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12590722&dopt=Abstract

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Liposarcoma of the spermatic cord masquerading as an incarcerated inguinal hernia. Author(s): Hassan JM, Quisling SV, Melvin WV, Sharp KW. Source: The American Surgeon. 2003 February; 69(2): 163-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12641360&dopt=Abstract

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Local anaesthesia in elective inguinal hernia repair: a randomised, double-blind study comparing the efficacy of levobupivacaine with racemic bupivacaine. Author(s): Kingsnorth AN, Cummings CG, Bennett DH. Source: The European Journal of Surgery = Acta Chirurgica. 2002; 168(7): 391-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12463428&dopt=Abstract

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Local injection for the treatment of suture site pain after laparoscopic ventral hernia repair. Author(s): Carbonell AM, Harold KL, Mahmutovic AJ, Hassan R, Matthews BD, Kercher KW, Sing RF, Heniford BT. Source: The American Surgeon. 2003 August; 69(8): 688-91; Discussion 691-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12953827&dopt=Abstract

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Local or general anesthesia for open hernia repair: a randomized trial. Author(s): O'Dwyer PJ, Serpell MG, Millar K, Paterson C, Young D, Hair A, Courtney CA, Horgan P, Kumar S, Walker A, Ford I. Source: Annals of Surgery. 2003 April; 237(4): 574-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12677155&dopt=Abstract

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Local, regional, or general anaesthesia in groin hernia repair: multicentre randomised trial. Author(s): Nordin P, Zetterstrom H, Gunnarsson U, Nilsson E. Source: Lancet. 2003 September 13; 362(9387): 853-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=13678971&dopt=Abstract

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Male genital tract injuries after contemporary inguinal hernia repair. Author(s): Ridgway PF, Shah J, Darzi AW. Source: Bju International. 2002 August; 90(3): 272-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12133064&dopt=Abstract

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Management of chronic postoperative pain following incisional hernia repair with Composix mesh: a report of two cases. Author(s): LeBlanc KA, Whitaker JM. Source: Hernia : the Journal of Hernias and Abdominal Wall Surgery. 2002 December; 6(4): 194-7. Epub 2002 September 11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12424601&dopt=Abstract

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Management of traumatic abdominal wall hernia. Author(s): Lane CT, Cohen AJ, Cinat ME. Source: The American Surgeon. 2003 January; 69(1): 73-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12575786&dopt=Abstract

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Management of umbilical hernia in patients with advanced liver disease. Author(s): McAlister V. Source: Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society. 2003 June; 9(6): 623-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12783406&dopt=Abstract

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Massive abdominal wall hernia--coincidence of bilateral semilunar hernias and a linea alba hernia. Author(s): Yamamoto N, Nakai H. Source: Annals of Plastic Surgery. 1999 August; 43(2): 220-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10454336&dopt=Abstract

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Massive hiatal hernia. Author(s): Villa A, Ceriani G, Negrini M, Ubezio D. Source: Journal of Accident & Emergency Medicine. 1999 July; 16(4): 301-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10417948&dopt=Abstract

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Massive incisional hernia of the bowel and urinary bladder: a case report. Author(s): Boughey JC, Nottingham JM. Source: The American Surgeon. 2002 October; 68(10): 892-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12412718&dopt=Abstract

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Meconium thorax: A case of Bochdalek hernia and cecal perforation in a neonate with Job's syndrome. Author(s): Butterworth SA, Webber EM. Source: Journal of Pediatric Surgery. 2002 April; 37(4): 673-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11912536&dopt=Abstract

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Mesenteric hernia: a rare cause of intestinal obstruction in children. Author(s): Garignon C, Paparel P, Liloku R, Lansiaux S, Basset T. Source: Journal of Pediatric Surgery. 2002 October; 37(10): 1493-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12378465&dopt=Abstract

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Mesh penetration of the sigmoid colon following a transabdominal preperitoneal hernia repair. Author(s): Lange B, Langer C, Markus PM, Becker H. Source: Surgical Endoscopy. 2003 January; 17(1): 157. Epub 2002 October 29. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12399870&dopt=Abstract

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Mesh plug migration into scrotum: a new complication of hernia repair. Author(s): Dieter RA Jr. Source: Int Surg. 1999 January-March; 84(1): 57-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10421020&dopt=Abstract

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Mesh repair of sacral hernia following sacrectomy. Author(s): Atkin G, Mathur P, Harrison R. Source: Journal of the Royal Society of Medicine. 2003 January; 96(1): 28-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12519800&dopt=Abstract

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Meta-analyses of randomized controlled trials of laparoscopic vs conventional inguinal hernia repairs. Author(s): Chung RS, Rowland DY. Source: Surgical Endoscopy. 1999 July; 13(7): 689-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10384076&dopt=Abstract

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Meta-analysis of laparoscopic inguinal hernia repair favors open hernia repair with preperitoneal mesh prosthesis. Author(s): Slim K. Source: American Journal of Surgery. 2003 April; 185(4): 395; Author Reply 395. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12657399&dopt=Abstract

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Meta-analysis of laparoscopic inguinal hernia trials favors open hernia repair with preperitoneal mesh prosthesis. Author(s): Voyles CR, Hamilton BJ, Johnson WD, Kano N. Source: American Journal of Surgery. 2002 July; 184(1): 6-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12135710&dopt=Abstract

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Methods of repair and risk for reoperation in Swedish hernia surgery from 1992 to 1996. Author(s): Nilsson E, Haapaniemi S, Gruber G, Sandblom G. Source: The British Journal of Surgery. 1998 December; 85(12): 1686-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9876075&dopt=Abstract

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Minimally invasive approaches to inguinal hernia repair. Author(s): Safadi BY, Duh QY. Source: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A. 2001 December; 11(6): 361-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11814126&dopt=Abstract

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Minimally invasive preperitoneal inguinal hernia repair with epidural anaesthesia. Author(s): Salihoglu Z, Demiroluk S, Yavuz N. Source: Anaesthesia and Intensive Care. 2002 December; 30(6): 813-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12500526&dopt=Abstract

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Minimally invasive repair of recurrent strangulated umbilical hernia in cirrhotic patient with refractory ascites. Author(s): Sarit C, Eliezer A, Mizrahi S. Source: Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society. 2003 June; 9(6): 621-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12783405&dopt=Abstract

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Missed traumatic hernia of the abdominal wall after contralateral pelvic and acetabular fracture. Author(s): Borens O, Bettschart V, Fischer JF, Mouhsine E. Source: The Journal of Trauma. 2003 March; 54(3): 626. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12634550&dopt=Abstract

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Modified posterior preperitoneal mesh hernioplasty for repair of inguinal hernia. Author(s): Akinci OF, Duzgun SA, Bozer M, Coskun A, Uzunkoy A. Source: The European Journal of Surgery = Acta Chirurgica. 1999 May; 165(5): 500-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10391170&dopt=Abstract

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Modified Ventilatory Index (MVI) in newborns with congenital diaphragmatic hernia (CDH). Author(s): Ilce Z, Celayir S. Source: Indian Pediatrics. 2003 September; 40(9): 920. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14530569&dopt=Abstract

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Morbidity and mortality of inguinal hernia in the newborn. Author(s): Ameh EA. Source: Niger Postgrad Med J. 2002 December; 9(4): 233-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12690685&dopt=Abstract

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Morgagni hernia and thoracic deformities. Author(s): Mouroux J, Venissac N, Alifano M, Padovani B. Source: The Thoracic and Cardiovascular Surgeon. 2003 February; 51(1): 44-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12587089&dopt=Abstract

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Morgagni hernia in adult presenting as cardiomegaly. Author(s): Sajeev CG, Francis J, Roy TN, Fassaludeen M, Venugopal K. Source: J Assoc Physicians India. 2003 January; 51: 85-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12693469&dopt=Abstract

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Morgagni hernia with Down syndrome: a rare association -- case report and review of literature. Author(s): Parmar RC, Tullu MS, Bavdekar SB, Borwankar SS. Source: Journal of Postgraduate Medicine. 2001 July-September; 47(3): 188-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11832621&dopt=Abstract

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Morgagni hernia. Author(s): Yadav RK, Sukhija S. Source: Indian J Chest Dis Allied Sci. 2001 July-September; 43(3): 163-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11529435&dopt=Abstract

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Morgagni hernia: case report. Author(s): Jani PG. Source: East Afr Med J. 2001 October; 78(10): 559-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11921604&dopt=Abstract

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Morgagni hernia: CT findings. Author(s): Anthes TB, Thoongsuwan N, Karmy-Jones R. Source: Current Problems in Diagnostic Radiology. 2003 May-June; 32(3): 135-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12783082&dopt=Abstract

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Morgagni hernia: rare presentations in elderly patients. Author(s): Guven H, Malazgirt Z, Dervisoglu A, Danaci M, Ozkan K. Source: Acta Chir Belg. 2002 August; 102(4): 266-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12244908&dopt=Abstract

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Needlescopic inguinal hernia repair in children. Author(s): Shalaby R, Desoky A. Source: Pediatric Surgery International. 2002 March; 18(2-3): 153-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11956783&dopt=Abstract

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Neonatal acute appendicitis: a strangulated appendix in an incarcerated inguinal hernia. Author(s): Martins JL, Peterlini FL, Martins EC. Source: Pediatric Surgery International. 2001 November; 17(8): 644-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11727059&dopt=Abstract

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Neonates with congenital diaphragmatic hernia have smaller neck veins than other neonates-An alternative route for ECMO cannulation. Author(s): Frenckner B, Palmer K, Linden V. Source: Journal of Pediatric Surgery. 2002 June; 37(6): 906-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12037760&dopt=Abstract

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Nerve irritation after laparoscopic hernia repair. Author(s): Stark E, Oestreich K, Wendl K, Rumstadt B, Hagmuller E. Source: Surgical Endoscopy. 1999 September; 13(9): 878-81. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10449843&dopt=Abstract

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Neurodevelopmental outcome after congenital diaphragmatic hernia: Extracorporeal membrane oxygenation before and after surgery. Author(s): Rasheed A, Tindall S, Cueny DL, Klein MD, Delaney-Black V. Source: Journal of Pediatric Surgery. 2001 April; 36(4): 539-44. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11283873&dopt=Abstract

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New method for paracolostomy hernia repair? Author(s): Stelzner S, Hellmich G, Ludwig K. Source: Diseases of the Colon and Rectum. 1999 June; 42(6): 823. Erratum In: Dis Colon Rectum 1999 July; 42(7): 880. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10378610&dopt=Abstract

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New method of inguinal hernia repair: a new solution. Author(s): Losanoff JE, Jones JW, Richman BW. Source: Anz Journal of Surgery. 2001 November; 71(11): 680-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11736834&dopt=Abstract

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New method of inguinal hernia repair: a new solution. Author(s): Desarda MP. Source: Anz Journal of Surgery. 2001 April; 71(4): 241-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11355734&dopt=Abstract

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New surgical procedure for sliding inguinal hernia repair in female infants and girls. Author(s): Kaneko K, Ando H, Tsuda M. Source: Journal of the American College of Surgeons. 2002 April; 194(4): 544-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11949760&dopt=Abstract

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Newly developing hiatus hernia: a survey in patients undergoing upper gastrointestinal endoscopy. Author(s): Loffeld RJ, van der Putten AB. Source: Journal of Gastroenterology and Hepatology. 2002 May; 17(5): 542-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12084026&dopt=Abstract

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Nihilism in the 1990s: the true mortality of congenital diaphragmatic hernia. Author(s): Stege G, Fenton A, Jaffray B. Source: Pediatrics. 2003 September; 112(3 Pt 1): 532-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12949279&dopt=Abstract

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Noninvasive delivery of inhaled nitric oxide therapy for late pulmonary hypertension in newborn infants with congenital diaphragmatic hernia. Author(s): Kinsella JP, Parker TA, Ivy DD, Abman SH. Source: The Journal of Pediatrics. 2003 April; 142(4): 397-401. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12712057&dopt=Abstract

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Nutritional morbidity in survivors of congenital diaphragmatic hernia. Author(s): Muratore CS, Utter S, Jaksic T, Lund DP, Wilson JM. Source: Journal of Pediatric Surgery. 2001 August; 36(8): 1171-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11479850&dopt=Abstract

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Obstructing sigmoid cancer with local invasion in an incarcerated inguinal hernia. Author(s): Tan GY, Guy RJ, Eu KW. Source: Anz Journal of Surgery. 2003 January-February; 73(1-2): 80-2. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12534750&dopt=Abstract

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Obturator hernia repair--a new technique. Author(s): Maharaj D, Maharaj S, Young L, Ramdass MJ, Naraynsingh V. Source: Hernia : the Journal of Hernias and Abdominal Wall Surgery. 2002 March; 6(1): 45-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12090583&dopt=Abstract

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Obturator hernia. Author(s): Losanoff JE, Richman BW, Jones JW. Source: Journal of the American College of Surgeons. 2002 May; 194(5): 657-63. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12022607&dopt=Abstract

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Obturator hernia. Author(s): Pippert H, Messmer P. Source: Jbr-Btr. 1999 June; 82(3): 122. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11155879&dopt=Abstract

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Obturator hernia: laparoscopic diagnosis and repair. Author(s): Haith LR Jr, Simeone MR, Reilly KJ, Patton ML, Moss BE, Shotwell BA. Source: Jsls. 1998 April-June; 2(2): 191-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9876738&dopt=Abstract

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Obturator hernia: the plug technique. Author(s): Martinez Insua C, Costa Pereira JM, Cardoso de Oliveira M. Source: Hernia : the Journal of Hernias and Abdominal Wall Surgery. 2001 September; 5(3): 161-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11759805&dopt=Abstract

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Obturator neuropathy due to obturator hernia. Author(s): Mondelli M, Giannini F, Guazzi G, Corbelli P. Source: Muscle & Nerve. 2002 August; 26(2): 291-2. Erratum In: Muscle Nerve 2002 December; 26(6): 858. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12210397&dopt=Abstract

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Occupational rehabilitation following open mesh surgical repair of an inguinal hernia. Author(s): Pesanelli KE, Cigna JA, Basu SG, Morin AR. Source: Physical Therapy. 2003 January; 83(1): 58-66. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12495413&dopt=Abstract

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Octreotide for treatment of chylothorax after repair of congenital diaphragmatic hernia. Author(s): Goyal A, Smith NP, Jesudason EC, Kerr S, Losty PD. Source: Journal of Pediatric Surgery. 2003 August; 38(8): E19-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12891519&dopt=Abstract

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Omental herniation through a 3-mm umbilical trocar site: unmasking a hidden umbilical hernia. Author(s): Bergemann JL, Hibbert ML, Harkins G, Narvaez J, Asato A. Source: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A. 2001 June; 11(3): 171-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11441996&dopt=Abstract

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On the extraperitoneal origin of hernia. Author(s): Stoppa R. Source: Hernia : the Journal of Hernias and Abdominal Wall Surgery. 2001 March; 5(1): 57. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11387728&dopt=Abstract

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One-thousand consecutive inguinal hernia repairs under unmonitored local anesthesia. Author(s): Callesen T, Bech K, Kehlet H. Source: Anesthesia and Analgesia. 2001 December; 93(6): 1373-6, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11726409&dopt=Abstract

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Open mesh versus non-mesh for repair of femoral and inguinal hernia. Author(s): Scott NW, McCormack K, Graham P, Go PM, Ross SJ, Grant AM. Source: Cochrane Database Syst Rev. 2002; (4): Cd002197. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12519568&dopt=Abstract

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Open mesh-plug technique in inguinal hernia repair--short-term results. Author(s): Seleem MI. Source: S Afr J Surg. 2003 May; 41(2): 44-7; Discussion 47. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12889242&dopt=Abstract

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Open tension-free mesh repair for adult inguinal hernia: eight years of experience in a community hospital. Author(s): Yamamoto S, Maeda T, Uchida Y, Yabe S, Nakano M, Sakano S, Yamamoto M. Source: Asian J Surg. 2002 April; 25(2): 121-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12376230&dopt=Abstract

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Open vs laparoscopic repair of spigelian hernia: a prospective randomized trial. Author(s): Moreno-Egea A, Carrasco L, Girela E, Martin JG, Aguayo JL, Canteras M. Source: Archives of Surgery (Chicago, Ill. : 1960). 2002 November; 137(11): 1266-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12413315&dopt=Abstract

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Operative findings in recurrent hernia after a Lichtenstein procedure. Author(s): Bay-Nielsen M, Nordin P, Nilsson E, Kehlet H; Danish Hernia Data Base and the Swedish Hernia Data Base. Source: American Journal of Surgery. 2001 August; 182(2): 134-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11574083&dopt=Abstract

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Operative techniques in inguinal hernia repair associated with patients returning to work. Author(s): Himal HS. Source: Surgery. 2002 June; 131(6): 694; Author Reply 694-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12075190&dopt=Abstract

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Optimal mesh size for endoscopic inguinal hernia repair: a study in a porcine model. Author(s): Knook MT, van Rosmalen AC, Yoder BE, Kleinrensink GJ, Snijders CJ, Looman CW, van Steensel CJ. Source: Surgical Endoscopy. 2001 December; 15(12): 1471-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11965468&dopt=Abstract

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Outcome at 2 years of infants with congenital diaphragmatic hernia: a populationbased study. Author(s): Jaillard SM, Pierrat V, Dubois A, Truffert P, Lequien P, Wurtz AJ, Storme L. Source: The Annals of Thoracic Surgery. 2003 January; 75(1): 250-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12537224&dopt=Abstract

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Outcome of congenital diaphragmatic hernia. Author(s): Beresford MW, Shaw NJ. Source: Pediatric Pulmonology. 2000 September; 30(3): 249-56. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10973043&dopt=Abstract

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Outcome of inguinal hernia repair total extraperitoneal laparoscopic hernia repair versus open tension free repair (Lichtenstein technique). Author(s): Subwongcharoen S. Source: J Med Assoc Thai. 2002 October; 85(10): 1100-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12501902&dopt=Abstract

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Outcome of laparoscopic ventral hernia repair in correlation with obesity, type of hernia, and hernia size. Author(s): Raftopoulos I, Vanuno D, Khorsand J, Ninos J, Kouraklis G, Lasky P. Source: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A. 2002 December; 12(6): 425-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12590723&dopt=Abstract

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Outcome of patients with severe chronic groin pain following repair of groin hernia (Br J Surg 2002; 89: 1310-1315). Author(s): Swarnkar KJ, Hooper N, Stephenson BM. Source: The British Journal of Surgery. 2003 March; 90(3): 367-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12594675&dopt=Abstract

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Outcome of patients with severe chronic pain following repair of groin hernia. Author(s): Courtney CA, Duffy K, Serpell MG, O'Dwyer PJ. Source: The British Journal of Surgery. 2002 October; 89(10): 1310-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12296903&dopt=Abstract

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Outcomes analysis for groin hernia repairs. Author(s): Voyles CR. Source: The Surgical Clinics of North America. 2003 October; 83(5): 1279-87. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14533915&dopt=Abstract

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Outcomes of laparoscopic fundoplication for gastroesophageal reflux disease and paraesophageal hernia. Author(s): Terry M, Smith CD, Branum GD, Galloway K, Waring JP, Hunter JG. Source: Surgical Endoscopy. 2001 July; 15(7): 691-9. Epub 2001 May 07. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11591970&dopt=Abstract

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Ovarian and tubal inguinal hernia--an unusual presentation. Author(s): Ray S, Som SC, Adedji EA, Williams GT, Ferguson A. Source: Journal of Obstetrics and Gynaecology : the Journal of the Institute of Obstetrics and Gynaecology. 2003 May; 23(3): 323-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12918500&dopt=Abstract

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Ovarian obturator hernia. Author(s): Yoshida S, Shidoh M, Shibuya H, Nishida R. Source: Lancet. 2002 August 31; 360(9334): 715. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12241892&dopt=Abstract

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Ovary in hernia sac: prolapsed or a descended gonad? Author(s): Ozbey H, Ratschek M, Schimpl G, Hollwarth ME. Source: Journal of Pediatric Surgery. 1999 June; 34(6): 977-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10392917&dopt=Abstract

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Pain from primary inguinal hernia and the effect of repair on pain. Author(s): Page B, Paterson C, Young D, O'Dwyer PJ. Source: The British Journal of Surgery. 2002 October; 89(10): 1315-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12296904&dopt=Abstract

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Paraesophageal hernia: when to operate? Author(s): Stylopoulos N, Rattner DW. Source: Adv Surg. 2003; 37: 213-29. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12953635&dopt=Abstract

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Parahiatal hernia with gastric obstruction in a child. Author(s): Chattopadhyay A, Prakash B, Vijayakumar, Nagendhar Y. Source: Indian J Gastroenterol. 2003 May-June; 22(3): 107-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12839389&dopt=Abstract

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Parapubic hernia: case report and review of the literature. Author(s): Losanoff JE, Richman BW, Jones JW. Source: Hernia : the Journal of Hernias and Abdominal Wall Surgery. 2002 July; 6(2): 825. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12152645&dopt=Abstract

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Paravertebral block anesthesia for inguinal hernia repair. Author(s): Weltz CR, Klein SM, Arbo JE, Greengrass RA. Source: World Journal of Surgery. 2003 April; 27(4): 425-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12658486&dopt=Abstract

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Partial preoperative reduction of inguinal hernia through compression with an ultrasound transducer. Author(s): Koseoglu K, Ozsunar Y, Taskin F, Unsal A. Source: Journal of Clinical Ultrasound : Jcu. 2003 September; 31(7): 379-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12923884&dopt=Abstract

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Pathologic quiz case: hypoplastic digit, diaphragmatic hernia, and agenesis of the corpus callosum in a 21(5/7)-week fetus. Fryns syndrome. Author(s): Mengshol SC, Ornvold K. Source: Archives of Pathology & Laboratory Medicine. 2003 November; 127(11): E425-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14567736&dopt=Abstract

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Perforated duodenal ulcer associated with an incarcerated hiatal hernia: report of a case. Author(s): Otsuka Y, Nara S, Ito K, Nakajima K, Mieno H, Konishi T. Source: Surgery Today. 2002; 32(12): 1085-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12541028&dopt=Abstract

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Perinatal management and outcome of prenatally diagnosed congenital diaphragmatic hernia: a 1995-2000 series in Rennes University Hospital. Author(s): Betremieux P, Lionnais S, Beuchee A, Pladys P, Le Bouar G, Pasquier L, Loeuillet-Olivo L, Azzis O, Milon J, Wodey E, Fremond B, Odent S, Poulain P. Source: Prenatal Diagnosis. 2002 November; 22(11): 988-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12424762&dopt=Abstract

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Pfannenstiel incision for incarcerated inguinal hernia in neonates. Author(s): Koga H, Yamataka A, Ohshiro K, Okada Y, Lane GJ, Miyano T. Source: Journal of Pediatric Surgery. 2003 August; 38(8): E16-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12891518&dopt=Abstract

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Planned reduction of incarcerated groin hernias with hernia sac laparoscopy. Author(s): Lin E, Wear K, Tiszenkel HI. Source: Surgical Endoscopy. 2002 June; 16(6): 936-8. Epub 2002 February 27. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12163958&dopt=Abstract

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Polyester (Parietex) mesh for total extraperitoneal laparoscopic inguinal hernia repair: initial experience in the United States. Author(s): Ramshaw B, Abiad F, Voeller G, Wilson R, Mason E. Source: Surgical Endoscopy. 2003 March; 17(3): 498-501. Epub 2002 November 20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12436235&dopt=Abstract

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Postoperative colonic perforation in a right-sided congenital diaphragmatic hernia in an adult. Author(s): Court FG, Wemyss-Holden SA, Maddern GJ. Source: Int Surg. 2003 January-March; 88(1): 9-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12731724&dopt=Abstract

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Postoperative complications after laparoscopic incisional hernia repair. Incidence and treatment. Author(s): Berger D, Bientzle M, Muller A. Source: Surgical Endoscopy. 2002 December; 16(12): 1720-3. Epub 2002 September 06. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12209325&dopt=Abstract

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Postoperative convalescence after inguinal hernia surgery: prospective randomized multicenter study of laparoscopic versus shouldice inguinal hernia repair in 1042 patients. Author(s): Berndsen F, Arvidsson D, Enander LK, Leijonmarck CE, Wingren U, Rudberg C, Smedberg S, Wickbom G, Montgomery A. Source: Hernia : the Journal of Hernias and Abdominal Wall Surgery. 2002 July; 6(2): 5661. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12152639&dopt=Abstract

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Postoperative perineal hernia repairing technique. Author(s): Martin Fernandez J, Martin Duce A, Noguerales F, Lasa I, Granell J. Source: The European Journal of Surgery = Acta Chirurgica. 2001 September; 167(9): 713-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11759745&dopt=Abstract

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Postoperative perineal hernia. Author(s): Abdul Jabbar AS. Source: Hernia : the Journal of Hernias and Abdominal Wall Surgery. 2002 December; 6(4): 188-90. Epub 2002 October 01. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12424599&dopt=Abstract

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Postoperative pulmonary dysfunction after bilateral inguinal hernia repair: a prospective randomized study comparing the Stoppa procedure with laparoscopic total extraperitoneal repair (TEPP). Author(s): Suter M, Martinet O. Source: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques. 2002 December; 12(6): 420-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12496548&dopt=Abstract

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Post-traumatic herniation of the liver, gallbladder, right colon, ileum, and right ovary through a Bochdalek hernia. Author(s): Rimpilainen J, Kariniemi J, Wiik H, Biancari F, Juvonen T. Source: The European Journal of Surgery = Acta Chirurgica. 2002; 168(11): 646-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12699104&dopt=Abstract

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Pre-ECMO predictors of nonsurvival in congenital diaphragmatic hernia. Author(s): Thibeault DW, Olsen SL, Truog WE, Hubbell MM. Source: Journal of Perinatology : Official Journal of the California Perinatal Association. 2002 December; 22(8): 682-3; Author Reply 684. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12478457&dopt=Abstract

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Prenatal sonographic chest and lung measurements for predicting severe pulmonary hypoplasia in left-sided congenital diaphragmatic hernia. Author(s): Nakata M, Sase M, Anno K, Sumie M, Hasegawa K, Nakamura Y, Kato H. Source: Early Human Development. 2003 May; 72(1): 75-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12706314&dopt=Abstract

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Preoperative diagnosis of obturator hernia. Author(s): Losanoff JE, Richman BW, Jones JW. Source: The Journal of Emergency Medicine. 2002 July; 23(1): 87-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12217478&dopt=Abstract

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Preoperative diagnosis of strangulated obturator hernia using ultrasonography. Author(s): Losanoff J, Kjossev K. Source: American Journal of Surgery. 1999 June; 177(6): 525-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10414709&dopt=Abstract

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Pre-operative sonographic diagnosis of incarcerated neonatal Spigelian hernia containing the testis. Author(s): Levy G, Nagar H, Blachar A, Ben-Sira L, Kessler A. Source: Pediatric Radiology. 2003 June; 33(6): 407-9. Epub 2003 April 12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12692696&dopt=Abstract

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Prognostic factors in childhood inguinal hernia at Wesley Guild Hospital, Ilesa, Nigeria. Author(s): Adesunkanmi AR, Adejuyigbe O, Agbakwuru EA. Source: East Afr Med J. 1999 March; 76(3): 144-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10442114&dopt=Abstract

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Progressive sliding hiatal hernia as a complication of Menkes' syndrome. Author(s): Shiihara T, Kato M, Honma T, Kimura T, Matsunaga A, Kodama H, Hayasaka K. Source: Journal of Child Neurology. 2002 May; 17(5): 401-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12150594&dopt=Abstract

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Prolene Hernia System compared with Lichtenstein patch: a randomised double blind study of short-term and medium-term outcomes in primary inguinal hernia repair. Author(s): Kingsnorth AN, Wright D, Porter CS, Robertson G. Source: Hernia : the Journal of Hernias and Abdominal Wall Surgery. 2002 September; 6(3): 113-9. Epub 2002 July 31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12209299&dopt=Abstract

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Prolonged use of pancuronium bromide and sensorineural hearing loss in childhood survivors of congenital diaphragmatic hernia. Author(s): Cheung PY, Tyebkhan JM, Peliowski A, Ainsworth W, Robertson CM. Source: The Journal of Pediatrics. 1999 August; 135(2 Pt 1): 233-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10431119&dopt=Abstract

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Prospective randomised controlled trial of laparoscopic versus open inguinal hernia mesh repair: five year follow up. Author(s): Douek M, Smith G, Oshowo A, Stoker DL, Wellwood JM. Source: Bmj (Clinical Research Ed.). 2003 May 10; 326(7397): 1012-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12742923&dopt=Abstract

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Prospective randomized trial of pre-emptive analgesics following ambulatory inguinal hernia repair: intravenous ketorolac versus diclofenac suppository. Author(s): Lau H, Wong C, Goh LC, Patil NG, Lee F. Source: Anz Journal of Surgery. 2002 October; 72(10): 704-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12534378&dopt=Abstract

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Quantitative analysis of collagen and elastic fibers in the transversalis fascia in direct and indirect inguinal hernia. Author(s): Rodrigues Junior AJ, Rodrigues CJ, da Cunha AC, Jin Y. Source: Revista Do Hospital Das Clinicas. 2002 November-December; 57(6): 265-70. Epub 2003 February 17. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12612758&dopt=Abstract

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Quiz case of the month. Latero-ventral hernia of the abdominal wall (Spigelian hernia). Author(s): Amodio F, Hierholzer J, Mansueto G, Lemke A, Smaltino F. Source: European Radiology. 2000; 10(11): 1839-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11097420&dopt=Abstract

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Randomized clinical trial comparing suture and mesh repair of umbilical hernia in adults (Br J Surg 2001;88:1321-3). Author(s): Thoman DS. Source: The British Journal of Surgery. 2002 May; 89(5): 627; Author Reply 628. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12019507&dopt=Abstract

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Randomized clinical trial comparing suture and mesh repair of umbilical hernia in adults (Br J Surg 2001;88:1321-3). Author(s): Chant H, Tsai P, Kingsworth A. Source: The British Journal of Surgery. 2002 May; 89(5): 627-8; Author Reply 628. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12019506&dopt=Abstract

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Randomized controlled study of laparoscopic total extraperitoneal versus open Lichtenstein inguinal hernia repair. Author(s): Lal P, Kajla RK, Chander J, Saha R, Ramteke VK. Source: Surgical Endoscopy. 2003 June; 17(6): 850-6. Epub 2003 March 28. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12658428&dopt=Abstract

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Re: Bilateral laparoscopic inguinal hernia repair can complicate subsequent radical retropubic prostatecomy. Author(s): Liedberg F. Source: The Journal of Urology. 2002 August; 168(2): 661; Author Reply 661-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12131339&dopt=Abstract

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Re: Bilateral laparoscopic inguinal hernia repair can complicate subsequent radical retropubic prostatectomy. Author(s): Kennedy-Smith A. Source: The Journal of Urology. 2003 April; 169(4): 1475-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12641083&dopt=Abstract

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Re: Bilateral laparoscopic inguinal hernia repair can complicate subsequent radical retropubic prostatectomy. Author(s): Foley CL, Kirby RS. Source: The Journal of Urology. 2003 April; 169(4): 1475. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12629393&dopt=Abstract

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Recurrence after laparoscopic ventral hernia repair. Author(s): Rosen M, Brody F, Ponsky J, Walsh RM, Rosenblatt S, Duperier F, Fanning A, Siperstein A. Source: Surgical Endoscopy. 2003 January; 17(1): 123-8. Epub 2002 September 23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12360375&dopt=Abstract

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Recurrence and pain three years after groin hernia repair. Validation of postal questionnaire and selective physical examination as a method of follow-up. Author(s): Haapaniemi S, Nilsson E. Source: The European Journal of Surgery = Acta Chirurgica. 2002; 168(1): 22-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12022367&dopt=Abstract

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Recurrence rate and hernia repair. Author(s): Cohen RV, Roll S, Schaffa TD, Junqueira AR. Source: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques. 1999 April; 9(2): 165-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11757549&dopt=Abstract

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Recurrences after conventional anterior and laparoscopic inguinal hernia repair: a randomized comparison. Author(s): Liem MS, van Duyn EB, van der Graaf Y, van Vroonhoven TJ; Coala Trial Group. Source: Annals of Surgery. 2003 January; 237(1): 136-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12496541&dopt=Abstract

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Recurrent diaphragmatic hernia. Author(s): Rowe DH, Stolar CJ. Source: Semin Pediatr Surg. 2003 May; 12(2): 107-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12728396&dopt=Abstract

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Recurrent hernia following endoscopic total extraperitoneal repair. Author(s): Chowbey PK, Bandyopadhyay SK, Sharma A, Khullar R, Soni V, Baijal M. Source: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A. 2003 February; 13(1): 21-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12676017&dopt=Abstract

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Recurrent spigelian hernia: a case report. Author(s): Losanoff JE, Richman BW, Jones JW. Source: The American Surgeon. 2003 February; 69(2): 109-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12641349&dopt=Abstract

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Reduced acute phase response after laparoscopic total extraperitoneal bilateral hernia repair compared to open repair with the Stoppa procedure. Author(s): Suter M, Martinet O, Spertini F. Source: Surgical Endoscopy. 2002 August; 16(8): 1214-9. Epub 2002 April 09. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12189483&dopt=Abstract

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Reflux esophagitis and its relationship to hiatal hernia. Author(s): Yeom JS, Park HJ, Cho JS, Lee SI, Park IS. Source: Journal of Korean Medical Science. 1999 June; 14(3): 253-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10402166&dopt=Abstract

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Relationship of sliding hiatus hernia to gastroesophageal reflux disease: a possible role for Helicobacter pylori infection? Author(s): Manes G, Pieramico O, Uomo G, Mosca S, de Nucci C, Balzano A. Source: Digestive Diseases and Sciences. 2003 February; 48(2): 303-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12643607&dopt=Abstract

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Repair of incisional hernia with prolene hernia system. Author(s): Miyauchi T, Ishikawa M, Tagami Y. Source: J Med Invest. 2003 February; 50(1-2): 108-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12630575&dopt=Abstract

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Repair of mild umbilical hernia. Author(s): Park S, Hata Y, Ito O, Tokioka K, Kagawa K. Source: Annals of Plastic Surgery. 1999 June; 42(6): 634-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10382800&dopt=Abstract

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Repeated boluses of local anaesthetic for pain relief after inguinal hernia repair. Author(s): Zieren J, Zieren HU, Jacobi CA, Muller JM. Source: The European Journal of Surgery = Acta Chirurgica. 1999 May; 165(5): 460-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10391163&dopt=Abstract

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Results of inguinal canal repair in athletes with sports hernia. Author(s): Kumar A, Doran J, Batt ME, Nguyen-Van-Tam JS, Beckingham IJ. Source: Journal of the Royal College of Surgeons of Edinburgh. 2002 June; 47(3): 561-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12109611&dopt=Abstract

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Retroperitoneal gas gangrene complicating elective inguinal hernia repair. Author(s): Privitera A, Edwards DP, Cunningham C. Source: J R Army Med Corps. 2001 October; 147(3): 309-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11766214&dopt=Abstract

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Reversed latissimus dorsi muscle flap for repair of recurrent congenital diaphragmatic hernia. Author(s): Sydorak RM, Hoffman W, Lee H, Yingling CD, Longaker M, Chang J, Smith B, Harrison MR, Albanese CT. Source: Journal of Pediatric Surgery. 2003 March; 38(3): 296-300; Discussion 296-300. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12632338&dopt=Abstract

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Review of wound healing with reference to an unrepairable abdominal hernia. Author(s): Junge K, Klinge U, Klosterhalfen B, Rosch R, Stumpf M, Schumpelick V. Source: The European Journal of Surgery = Acta Chirurgica. 2002; 168(2): 67-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12113273&dopt=Abstract

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Richter's hernia in the laparoscopic era: four case reports and review of the literature. Author(s): Boughey JC, Nottingham JM, Walls AC. Source: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques. 2003 February; 13(1): 55-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12598762&dopt=Abstract

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Risk of contralateral hydrocele or hernia after unilateral hydrocele repair in children. Author(s): Lym L, Ross JH, Alexander F, Kay R. Source: The Journal of Urology. 1999 September; 162(3 Pt 2): 1169-70; Discussion 1171. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10458458&dopt=Abstract

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Risk of femoral hernia after inguinal herniorrhaphy. Author(s): Mikkelsen T, Bay-Nielsen M, Kehlet H. Source: The British Journal of Surgery. 2002 April; 89(4): 486-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11952593&dopt=Abstract

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Role of the lower esophageal sphincter and hiatal hernia in the pathogenesis of gastroesophageal reflux disease. Author(s): Fein M, Ritter MP, DeMeester TR, Oberg S, Peters JH, Hagen JA, Bremner CG. Source: Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract. 1999 July-August; 3(4): 405-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10482693&dopt=Abstract

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Rotation flap of the anterior rectus abdominis sheath for hernia prevention in TRAM breast reconstruction. Author(s): Amir A, Silfen R, Hauben DJ. Source: Annals of Plastic Surgery. 2003 February; 50(2): 207-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12567063&dopt=Abstract

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Routine ultrasound for the prenatal diagnosis of congenital diaphragmatic hernia: the 'isms'. Author(s): Thilaganathan B. Source: Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2002 April; 19(4): 327-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11952958&dopt=Abstract

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Ruptured umbilical hernia in a case of alcoholic cirrhosis with massive ascites. Author(s): Granese J, Valaulikar G, Khan M, Hardy H 3rd. Source: The American Surgeon. 2002 August; 68(8): 733-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12206611&dopt=Abstract

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Safety of daycare hernia repair in Jos, Nigeria. Author(s): Ramyil VM, Iya D, Ogbonna BC, Dakum NK. Source: East Afr Med J. 2000 June; 77(6): 326-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12858934&dopt=Abstract

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Seroma after laparoscopic repair of hernia with PTFE patch: is it really a complication? Author(s): Susmallian S, Gewurtz G, Ezri T, Charuzi I. Source: Hernia : the Journal of Hernias and Abdominal Wall Surgery. 2001 September; 5(3): 139-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11759799&dopt=Abstract

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Severe, recurrent hiatal hernia in Schwartz syndrome. Author(s): Badshah S, Ghafoor T, Muhammad S. Source: J Coll Physicians Surg Pak. 2003 January; 13(1): 59-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12685982&dopt=Abstract

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Short-term outcomes of laparoscopic and open ventral hernia repair: a meta-analysis. Author(s): Goodney PP, Birkmeyer CM, Birkmeyer JD. Source: Archives of Surgery (Chicago, Ill. : 1960). 2002 October; 137(10): 1161-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12361426&dopt=Abstract

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Simultaneous surgical treatment of chronic post-traumatic aneurysm of the thoracic aorta, diaphragmatic hernia and giant emphysema bulla. Author(s): Luciani N, Lapenna E, De Bonis M, Pirronti T, Possati GF. Source: The Journal of Cardiovascular Surgery. 2002 October; 43(5): 747-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12386596&dopt=Abstract

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Sliding appendiceal inguinal hernia with a congenital fibrovascular band connecting the appendix vermiformis to the right testis. Author(s): Oguzkurt P, Kayaselcuk F, Oz S, Serdar Arda I, Oguzkurt L. Source: Hernia : the Journal of Hernias and Abdominal Wall Surgery. 2001 September; 5(3): 156-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11759803&dopt=Abstract

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Sliding appendiceal inguinal hernia: preoperative sonographic diagnosis. Author(s): Celik A, Ergun O, Ozbek SS, Dokumcu Z, Balik E. Source: Journal of Clinical Ultrasound : Jcu. 2003 March-April; 31(3): 156-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12594801&dopt=Abstract

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Sliding hiatal hernia with intrathoracic stomach and obstructed colon. Author(s): Clark AJ, Madiba TE. Source: S Afr J Surg. 2002 August; 40(3): 101-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12387220&dopt=Abstract

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Spigelian and other uncommon hernia repairs. Author(s): Montes IS, Deysine M. Source: The Surgical Clinics of North America. 2003 October; 83(5): 1235-53, Viii. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14533913&dopt=Abstract

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Spigelian hernia in a child: case report and review of the literature. Author(s): Losanoff JE, Richman BW, Jones JW. Source: Hernia : the Journal of Hernias and Abdominal Wall Surgery. 2002 December; 6(4): 191-3. Epub 2002 September 07. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12424600&dopt=Abstract

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Spigelian hernia long considered as diverticulitis: CT scan diagnosis and laparoscopic treatment. Computed tomography. Author(s): Habib E, Elhadad A. Source: Surgical Endoscopy. 2003 January; 17(1): 159. Epub 2002 October 29. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12399863&dopt=Abstract

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Spigelian hernia: bibliographical study and presentation of a series of 28 patients. Author(s): Moreno-Egea A, Flores B, Girela E, Martin JG, Aguayo JL, Canteras M. Source: Hernia : the Journal of Hernias and Abdominal Wall Surgery. 2002 December; 6(4): 167-70. Epub 2002 September 11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12424594&dopt=Abstract

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Spigelion hernia: fascia lata repair is an alternative option in absence of prolene mesh. Author(s): Ray NK, Sreeramulu PN, Krishnaprasad K. Source: J Indian Med Assoc. 2002 June; 100(6): 370-1, 384. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12416668&dopt=Abstract

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Spinal anaesthesia for inguinal hernia repair? Author(s): Kehlet H, Dahl JB. Source: Acta Anaesthesiologica Scandinavica. 2003 January; 47(1): 1-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12492789&dopt=Abstract

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Spondylothoracic dysostosis associated with diaphragmatic hernia and camptodactyly. Author(s): Swietlinski J, Swist-Szulik K, Maruniak-Chudek I, Pyrkosz A. Source: Genet Couns. 2002; 13(3): 309-17. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12416639&dopt=Abstract

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Spontaneous paracentesis through an umbilical hernia. Author(s): Podymow T, Sabbagh C, Turnbull J. Source: Cmaj : Canadian Medical Association Journal = Journal De L'association Medicale Canadienne. 2003 March 18; 168(6): 741. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12642434&dopt=Abstract

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Spontaneous rupture of incisional hernia--a case report. Author(s): Ogundiran TO, Ayantunde AA, Akute OO. Source: West Afr J Med. 2001 April-June; 20(2): 176-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11768022&dopt=Abstract

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Stapled and nonstapled laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair. A prospective randomized trial. Author(s): Smith AI, Royston CM, Sedman PC. Source: Surgical Endoscopy. 1999 August; 13(8): 804-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10430690&dopt=Abstract

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Strangulated inguinal hernia: an unusual presentation. Author(s): Haider MH, Ather M, Iqbal M, Khaliq T. Source: J Pak Med Assoc. 2003 January; 53(1): 36-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12666852&dopt=Abstract

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Strangulated left paraduodenal hernia in an infant. Author(s): Ramachandran P, Sridharan S. Source: Pediatric Surgery International. 2003 April; 19(1-2): 120-1. Epub 2003 March 29. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12721744&dopt=Abstract

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Strangulated obturator hernia: report of 2 cases. Author(s): Xu Q, Qiu Y, Xie M. Source: Chin Med J (Engl). 2002 September; 115(9): 1420-1. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12411128&dopt=Abstract

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Sublay prosthetic repair for incisional hernia of the flank. Author(s): Petersen S, Schuster F, Steinbach F, Henke G, Hellmich G, Ludwig K. Source: The Journal of Urology. 2002 December; 168(6): 2461-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12441940&dopt=Abstract

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Successful salvage of infected PTFE mesh after ventral hernia repair. Author(s): Kercher KW, Sing RF, Matthews BD, Heniford BT. Source: Ostomy Wound Manage. 2002 October; 48(10): 40-2, 44-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12378002&dopt=Abstract

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Sudden death following a ventral hernia repair. Author(s): Gonzalez D, Lesho E. Source: Lancet. 2003 February 1; 361(9355): 391. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12573377&dopt=Abstract

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Surfactant phosphatidylcholine pool size in human neonates with congenital diaphragmatic hernia requiring ECMO. Author(s): Janssen DJ, Tibboel D, Carnielli VP, van Emmen E, Luijendijk IH, Darcos Wattimena JL, Zimmermann LJ. Source: The Journal of Pediatrics. 2003 March; 142(3): 247-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12640370&dopt=Abstract

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Surgical repair of intercostal pulmonary hernia secondary to cough induced rib fracture. Author(s): Ayers DE, LeFeuvre A, Barker P. Source: J R Nav Med Serv. 2002; 88(2): 55-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12500483&dopt=Abstract

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Surgical repair of primary saphenous vein aneurysm of the proximal leg after initial presentation as an inguinal hernia. Author(s): Majeski J. Source: The American Surgeon. 2002 November; 68(11): 999-1002. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12455795&dopt=Abstract

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Surgical treatment of para-oesophageal hiatal hernia. Author(s): Beggs D. Source: Annals of the Royal College of Surgeons of England. 2003 May; 85(3): 221. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12831499&dopt=Abstract

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Surgical treatment of para-oesophageal hiatal hernia. Author(s): Palazzo FF, Hashemi M, Cochrane J. Source: Annals of the Royal College of Surgeons of England. 2003 March; 85(2): 141. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12648356&dopt=Abstract

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Symptomatic forearm muscle hernia: repair by autologous fascia lata inlay. Author(s): Golshani SD, Lee C, Sydorak R. Source: Annals of Plastic Surgery. 1999 August; 43(2): 204-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10454331&dopt=Abstract

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Technique of mobilization and mesh fixation in laparoscopic hernia repair by transabdominal preperitoneal mesh prosthesis. Author(s): Steiner E, Bermoser K, Steiner P. Source: Digestive Surgery. 2002; 19(6): 500-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12499744&dopt=Abstract

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Tension-free inguinal hernia repair: TEP versus mesh-plug versus Lichtenstein: a prospective randomized controlled trial. Author(s): Bringman S, Ramel S, Heikkinen TJ, Englund T, Westman B, Anderberg B. Source: Annals of Surgery. 2003 January; 237(1): 142-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12496542&dopt=Abstract

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Tension-free inguinal hernia repair: the design of a trial to compare open and laparoscopic surgical techniques. Author(s): Neumayer L, Jonasson O, Fitzgibbons R, Henderson W, Gibbs J, Carrico CJ, Itani K, Kim L, Pappas T, Reda D, Dunlop D, McCarthy M, Hynes D, Giobbie-Hurder A, London MJ, Hatton-Ward S. Source: Journal of the American College of Surgeons. 2003 May; 196(5): 743-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12742208&dopt=Abstract

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The development of a clinical trial to determine if watchful waiting is an acceptable alternative to routine herniorrhaphy for patients with minimal or no hernia symptoms. Author(s): Fitzgibbons RJ, Jonasson O, Gibbs J, Dunlop DD, Henderson W, Reda D, Giobbie-Hurder A, McCarthy M. Source: Journal of the American College of Surgeons. 2003 May; 196(5): 737-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12742207&dopt=Abstract

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The effect of diaphragmatic stressors on recurrent hiatal hernia. Author(s): Kakarlapudi GV, Awad ZT, Haynatzki G, Sampson T, Stroup G, Filipi CJ. Source: Hernia : the Journal of Hernias and Abdominal Wall Surgery. 2002 December; 6(4): 163-6. Epub 2002 September 17. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12424593&dopt=Abstract

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The effects of the critical pathway for inguinal hernia repair. Author(s): Joh HJ, Moon IS, Park HR, Kim NC, Yang S. Source: Yonsei Medical Journal. 2003 February; 44(1): 81-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12619179&dopt=Abstract

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The groin hernia - an ultrasound diagnosis? Author(s): Bradley M, Morgan D, Pentlow B, Roe A. Source: Annals of the Royal College of Surgeons of England. 2003 May; 85(3): 178-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12831490&dopt=Abstract

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The importance of the size of Hessert's triangle in the etiology of inguinal hernia. Author(s): Abdalla RZ, Mittelstaedt WE. Source: Hernia : the Journal of Hernias and Abdominal Wall Surgery. 2001 September; 5(3): 119-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11759795&dopt=Abstract

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The incidence of spermatic cord structures in inguinal hernia sacs from male children. Author(s): Steigman CK, Sotelo-Avila C, Weber TR. Source: The American Journal of Surgical Pathology. 1999 August; 23(8): 880-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10435556&dopt=Abstract

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The lung-to-head ratio and fetoscopic temporary tracheal occlusion: prediction of survival in severe left congenital diaphragmatic hernia. Author(s): Keller RL, Glidden DV, Paek BW, Goldstein RB, Feldstein VA, Callen PW, Filly RA, Albanese CT. Source: Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2003 March; 21(3): 244-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12666218&dopt=Abstract

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The minilaparoscope as a tool for localization and preparation for cannula insertion in patients with multiple previous abdominal incisions or umbilical hernia. Author(s): Golan A, Sagiv R, Debby A, Glezerman M. Source: The Journal of the American Association of Gynecologic Laparoscopists. 2003 February; 10(1): 14-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12554988&dopt=Abstract

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The possibility of nervus ilioinguinalis and nervus iliohypogastricus injury in lower abdominal incisions and effects on hernia formation. Author(s): Avsar FM, Sahin M, Arikan BU, Avsar AF, Demirci S, Elhan A. Source: The Journal of Surgical Research. 2002 October; 107(2): 179-85. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12429173&dopt=Abstract

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The use of needlescopic instruments in laparoscopic ventral hernia repair. Author(s): Tagaya N, Aoki H, Mikami H, Kogure H, Kubota K. Source: Surgery Today. 2001; 31(10): 945-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11759898&dopt=Abstract

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The use of polypropylene mesh in midline incision closure following gastric by-pass surgery reduces the risk of postoperative hernia. Author(s): Strzelczyk J, Czupryniak L, Loba J, Wasiak J. Source: Langenbeck's Archives of Surgery / Deutsche Gesellschaft Fur Chirurgie. 2002 November; 387(7-8): 294-7. Epub 2002 October 23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12447555&dopt=Abstract

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The use of prosthetics in hernia repair. Author(s): Anwar S. Source: Hosp Med. 2003 January; 64(1): 34-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12572333&dopt=Abstract

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Thoracoscopic repair of cervical lung hernia. Author(s): Jheon S, Lee EB, Cho JY, Chang BH, Lee J, Kim KT. Source: The Journal of Thoracic and Cardiovascular Surgery. 2002 November; 124(5): 1030-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12407392&dopt=Abstract

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Thrombosed sapheno-varix presenting as an incarcerated femoral hernia in a postpartum woman. Author(s): Patel KA, Thwaini H, Cooper JC, Spooner SF. Source: Journal of Obstetrics and Gynaecology : the Journal of the Institute of Obstetrics and Gynaecology. 2003 July; 23(4): 456-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12881108&dopt=Abstract

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Total calcium content of sacs associated with inguinal hernia, hydrocele or undescended testis reflects differences dictated by programmed cell death. Author(s): Tanyel FC, Ulusu NN, Tezcan EF, Buyukpamukcu N. Source: Urologia Internationalis. 2003; 70(3): 211-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12660459&dopt=Abstract

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Totally extraperitoneal endoscopic inguinal hernia repair (TEP). Author(s): Tamme C, Scheidbach H, Hampe C, Schneider C, Kockerling F. Source: Surgical Endoscopy. 2003 February; 17(2): 190-5. Epub 2002 December 04. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12457220&dopt=Abstract

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Totally extraperitoneal laparoendoscopic repair of lumbar hernia. Author(s): Meinke AK. Source: Surgical Endoscopy. 2003 May; 17(5): 734-7. Epub 2003 March 07. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12618948&dopt=Abstract

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Transdiaphragmatic hernia 1 year after heart transplantation following implantable LVAD. Author(s): Mouly-Bandini A, Chalvignac V, Collart F, Caus T, Guidon C, Giudicelli R, Mesana T. Source: The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation. 2002 October; 21(10): 1144-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12398883&dopt=Abstract

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Transient left vocal cord paralysis during laparoscopic surgery for an oesophageal hiatus hernia. Author(s): Kanski A, Plocharska E, Stanowski E, Koziarski T, Chmurzynska A. Source: European Journal of Anaesthesiology. 1999 July; 16(7): 495-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10457884&dopt=Abstract

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Transmesenteric hernia: report of two patients with diagnostic emphasis on plain abdominal X-ray findings. Author(s): Fujita A, Takaya J, Takada K, Ishihara T, Hamada Y, Harada Y, Nakamura M, Kobayashi Y. Source: European Journal of Pediatrics. 2003 March; 162(3): 147-9. Epub 2003 January 15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12655416&dopt=Abstract

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Transmesosigmoid hernia: report of a case. Author(s): Sasaki T, Sakai K, Fukumori D, Sato M, Ohmori H, Yamamoto F. Source: Surgery Today. 2002; 32(12): 1096-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12541031&dopt=Abstract

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Transverse colon diverticulitis simulating inguinal hernia strangulation: a first report. Author(s): Yahchouchy-Chouillard EK, Aura TR, Lopez YN, Limot O, Fingerhut AL. Source: Digestive Surgery. 2002; 19(5): 408-9; Discussion 409. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12435915&dopt=Abstract

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Traumatic abdominal wall hernia--still a diagnostic dilemma! Author(s): Date R, Clements WD. Source: Ir Med J. 2003 February; 96(2): 57-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12674161&dopt=Abstract

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Traumatic diaphragmatic hernia in a patient with repaired eventration of diaphragm. Author(s): Gupta CR, Luthra M. Source: Indian Pediatrics. 2003 August; 40(8): 798-800. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12951393&dopt=Abstract

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Traumatic diaphragmatic hernia presenting as a tension fecopneumothorax. Author(s): Vermillion JM, Wilson EB, Smith RW. Source: Hernia : the Journal of Hernias and Abdominal Wall Surgery. 2001 September; 5(3): 158-60. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11759804&dopt=Abstract

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Traumatic hernia of the abdominal wall after pelvic and acetabular fracture: a case report. Author(s): Borens O, Fischer JF, Bettschart V, Mouhsine E. Source: Acta Orthop Belg. 2002 December; 68(5): 542-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12584987&dopt=Abstract

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Twenty years of progress in congenital diaphragmatic hernia at the University of Florida. Author(s): Langham MR Jr, Kays DW, Beierle EA, Chen MK, Mullet TC, Rieger K, Wood CE, Talbert JL. Source: The American Surgeon. 2003 January; 69(1): 45-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12575780&dopt=Abstract

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Ultrasonic diagnosis of strangulated obturator hernia. Author(s): Gilliam A, O'Boyle CJ, Wai D, Perry EP. Source: The European Journal of Surgery = Acta Chirurgica. 2000 May; 166(5): 420-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10881958&dopt=Abstract

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Ultrasonographic detection of herniation of stomach in paraumbilical hernia. Author(s): Saggar K, Goyal SC, Goyal R, Sodhi KS. Source: Indian J Gastroenterol. 1999 April-June; 18(2): 87-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10319543&dopt=Abstract

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Ultrasonographic evaluation of bilateral groins in children with unilateral inguinal hernia. Author(s): Kervancioglu R, Bayram MM, Ertaskin I, Ozkur A. Source: Acta Radiologica (Stockholm, Sweden : 1987). 2000 November; 41(6): 653-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11092492&dopt=Abstract

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Ultrasonographic measurement of the abdominal circumference in fetuses with congenital diaphragmatic hernia. Author(s): Rode ME, Jackson GM, Jenkins TM, Macones GA. Source: American Journal of Obstetrics and Gynecology. 2002 February; 186(2): 321-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11854658&dopt=Abstract

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Ultrasound diagnosis of fetal diaphragmatic hernia and complex congenital heart disease at 12 weeks' gestation--a case report. Author(s): Lam YH, Tang MH, Yuen ST. Source: Prenatal Diagnosis. 1998 November; 18(11): 1159-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9854725&dopt=Abstract

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Ultrasound diagnosis of occult femoral hernia presenting with intestinal obstruction. Author(s): Weng TI, Wang HP, Chen WJ, Chin LB, Ng LM. Source: The American Journal of Emergency Medicine. 2001 July; 19(4): 333-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11447539&dopt=Abstract

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Ultrasound-based volumetric evaluation of fluid retention after inguinal hernia repair. Author(s): Peiper C, Ponschek N, Truong S, Schumpelick V. Source: Surgical Endoscopy. 2000 July; 14(7): 666-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10948306&dopt=Abstract

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Ultrasound-guided reduction of a Spigelian hernia in a difficult case: an unusual use of bedside emergency ultrasonography. Author(s): Blaivas M. Source: The American Journal of Emergency Medicine. 2002 January; 20(1): 59-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11781920&dopt=Abstract

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Ultrasound-guided reduction of an incarcerated Spigelian hernia. Author(s): Torzilli G, Del Fabbro D, Felisi R, Leoni P, Gnocchi P, Lumachi V, Goglia P, Olivari N. Source: Ultrasound in Medicine & Biology. 2001 August; 27(8): 1133-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11527600&dopt=Abstract

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Umbilical and epigastric hernia repair. Author(s): Muschaweck U. Source: The Surgical Clinics of North America. 2003 October; 83(5): 1207-21. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14533911&dopt=Abstract

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Umbilical hernia in adults: day case local anaesthetic repair. Author(s): Menon VS, Brown TH. Source: Journal of Postgraduate Medicine. 2003 April-June; 49(2): 132-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12867688&dopt=Abstract

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Umbilical hernia, inguinal hernias, and hydroceles in children: diagnostic clues for optimal patient management. Author(s): Gill FT. Source: Journal of Pediatric Health Care : Official Publication of National Association of Pediatric Nurse Associates & Practitioners. 1998 September-October; 12(5): 231-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9987252&dopt=Abstract

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Unusual swallow syncope caused by huge hiatal hernia. Author(s): Maekawa T, Suematsu M, Shimada T, Go M, Shimada T. Source: Intern Med. 2002 March; 41(3): 199-201. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11929180&dopt=Abstract

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Unusual type of left paraduodenal hernia caused by a separated peritoneal membrane. Author(s): Nishida T, Mizushima T, Kitagawa T, Ito T, Sugiura T, Matsuda H. Source: Journal of Gastroenterology. 2002; 37(9): 742-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12375149&dopt=Abstract

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Update of hernia repair-1998. Author(s): Patton ML. Source: Jsls. 1999 January-March; 3(1): 88B. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10323180&dopt=Abstract

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Update: what is left for laparoscopic hernia repair? Author(s): Bittner R, Leibl B, Kraft K, Schwarz J, Schmedt CG. Source: Digestive Surgery. 1998; 15(2): 167-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9845581&dopt=Abstract

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Upregulated tumor necrosis factor-alpha gene expression in the hypoplastic lung in patients with congenital diaphragmatic hernia. Author(s): Ohshiro K, Miyazaki E, Taira Y, Puri P. Source: Pediatric Surgery International. 1998 November; 14(1-2): 21-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9880689&dopt=Abstract

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Uptake of F-18 FDG by a hiatal hernia. Author(s): Ahn SH, Scheiner JD, Noto RB. Source: Clinical Nuclear Medicine. 2002 October; 27(10): 733-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12352120&dopt=Abstract

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Urachal hernia: an unusual intra-abdominal hernia caused by incarceration into a urachal cyst. Author(s): Yamazaki T, Sakai Y, Hatakeyama K, Sekine Y, Yuki Y. Source: Digestive Diseases and Sciences. 2000 December; 45(12): 2365-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11258558&dopt=Abstract

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Ureteral sciatic hernia demonstrated on retrograde urography and surgically repaired with Boari flap technique. Author(s): Noller MW, Noller DW. Source: The Journal of Urology. 2000 September; 164(3 Pt 1): 776-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10953148&dopt=Abstract

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Use of clonidine in hernia patients: intramuscular versus surgical site. Author(s): Connelly NR, Reuben SS, Albert M, Page D, Gibson CS, Moineau A, Dixon KL, Maciolek H. Source: Regional Anesthesia and Pain Medicine. 1999 September-October; 24(5): 422-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10499753&dopt=Abstract

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Use of the prolene hernia system for inguinal hernia repair: retrospective, comparative time analysis versus other inguinal hernia repair systems. Author(s): Murphy JW. Source: The American Surgeon. 2001 October; 67(10): 919-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11603544&dopt=Abstract

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Using CT to diagnose traumatic lumbar hernia. Author(s): Killeen KL, Girard S, DeMeo JH, Shanmuganathan K, Mirvis SE. Source: Ajr. American Journal of Roentgenology. 2000 May; 174(5): 1413-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10789805&dopt=Abstract

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Vacuum-assisted closure for abdominal wound dehiscence with prosthesis exposure in hernia surgery. Author(s): de Vooght A, Feruzi G, Detry R, Lerut J, Vanwijck R. Source: Plastic and Reconstructive Surgery. 2003 September 15; 112(4): 1188-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12973257&dopt=Abstract

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Vaginal hysterectomy after previous ventral scar hernia repair. Author(s): Sheth SS, Ghoshal AA. Source: Journal of Obstetrics and Gynaecology : the Journal of the Institute of Obstetrics and Gynaecology. 2002 July; 22(4): 430-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12521472&dopt=Abstract

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Value of CT after laparoscopic repair of postsurgical ventral hernia. Author(s): Gossios K, Zikou A, Vazakas P, Passas G, Glantzouni A, Glantzounis G, Kontogiannis D, Tsimoyiannis E. Source: Abdominal Imaging. 2003 January-February; 28(1): 99-102. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12483396&dopt=Abstract

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Value of herniography in the management of occult hernia and chronic groin pain in adults. Author(s): Benson EA. Source: The British Journal of Surgery. 2001 January; 88(1): 154. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11202426&dopt=Abstract

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Value of herniography in the management of occult hernia and chronic groin pain in adults. Author(s): Evans DS. Source: The British Journal of Surgery. 2001 January; 88(1): 153-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11202425&dopt=Abstract

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Value of herniography in the management of occult hernia and chronic groin pain in adults. Author(s): Calder F, Evans R, Neilson D, Hurley P. Source: The British Journal of Surgery. 2000 June; 87(6): 824-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10848865&dopt=Abstract

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Variability of inguinal hernia surgical technique: A survey of North American pediatric surgeons. Author(s): Levitt MA, Ferraraccio D, Arbesman MC, Brisseau GF, Caty MG, Glick PL. Source: Journal of Pediatric Surgery. 2002 May; 37(5): 745-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11987092&dopt=Abstract

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Venoarterial versus venovenous extracorporeal membrane oxygenation in congenital diaphragmatic hernia: the Extracorporeal Life Support Organization Registry, 19901999. Author(s): Dimmitt RA, Moss RL, Rhine WD, Benitz WE, Henry MC, Vanmeurs KP. Source: Journal of Pediatric Surgery. 2001 August; 36(8): 1199-204. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11479856&dopt=Abstract

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Venovenous versus venoarterial extracorporeal membrane oxygenation in congenital diaphragmatic hernia. Author(s): Kugelman A, Gangitano E, Pincros J, Tantivit P, Taschuk R, Durand M. Source: Journal of Pediatric Surgery. 2003 August; 38(8): 1131-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12891480&dopt=Abstract

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Ventilatory casebook. Late presentation of congenital diaphragmatic hernia in association with group B streptococcal sepsis and meningitis. Author(s): McGettigan MC. Source: Journal of Perinatology : Official Journal of the California Perinatal Association. 1998 November-December; 18(6 Pt 1): 485-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9848768&dopt=Abstract

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Ventilatory management casebook: recurrent diaphragmatic hernia. Author(s): McGettigan MC. Source: Journal of Perinatology : Official Journal of the California Perinatal Association. 1999 June; 19(4): 320-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10685248&dopt=Abstract

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Ventral bladder hernia following tubal ligation. Author(s): Pena AA, Bermejo CE, Thompson IM Jr. Source: The Journal of Urology. 2002 October; 168(4 Pt 1): 1502. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12352435&dopt=Abstract

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Ventral hernia of the urinary bladder with mixed urinary incontinence: treatment with herniorrhaphy and allograft fascial sling. Author(s): Rovner ES, Gomes CM, Banner MP, Wein AJ. Source: Urology. 2000 January; 55(1): 145. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10754165&dopt=Abstract

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Ventral hernia repair by the laparoscopic approach. Author(s): Larson GM. Source: The Surgical Clinics of North America. 2000 August; 80(4): 1329-40. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10987039&dopt=Abstract

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Ventral hernia repair: a study of current practice. Author(s): Courtney CA, Lee AC, Wilson C, O'Dwyer PJ. Source: Hernia : the Journal of Hernias and Abdominal Wall Surgery. 2003 March; 7(1): 44-6. Epub 2003 January 24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12612798&dopt=Abstract

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Ventral hernia resulting in increased fluorodeoxyglucose uptake on positron emission tomographic imaging. Author(s): Rebenstock A, Zhuang H, Hickeson M, Lau C, Alavi A. Source: Clinical Nuclear Medicine. 2002 December; 27(12): 920-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12607888&dopt=Abstract

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Ventral hernia synthetic mesh repair infected by Mycobacterium fortuitum. Author(s): Matthews MR, Caruso DM, Tsujimura RB, Smilack JD, Pockaj BA, Malone JM. Source: The American Surgeon. 1999 November; 65(11): 1035-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10551752&dopt=Abstract

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Ventral incisional hernia recurrence. Author(s): Clark JL. Source: The Journal of Surgical Research. 2001 July; 99(1): 33-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11421601&dopt=Abstract

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Vertical Mayo repair of midline incisional hernia: suggested guidelines for selection of patients. Author(s): Mittermair RP, Klingler A, Wykypiel H, Gadenstatter M. Source: The European Journal of Surgery = Acta Chirurgica. 2002; 168(6): 334-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12428870&dopt=Abstract

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Video-assisted thoracoscopic repair of an intercostal pulmonary hernia. Author(s): Van Den Bossche MR, Leman G, Ballaux KE, Himpens J. Source: Surgical Endoscopy. 1999 February; 13(2): 166-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9918623&dopt=Abstract

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Videolaparoscopy of the contralateral internal inguinal ring via the hernia sac in children with unilateral inguinal hernia-initial experience in Brazil, with a metaanalysis. Author(s): Eller Miranda M, Duarte Lanna JC. Source: Pediatric Surgery International. 2002 September; 18(5-6): 463-9. Epub 2002 July 23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12415382&dopt=Abstract

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Virgin and recurrent groin hernia: a comparison of patient recovery following endoscopic preperitoneal herniorrhaphy. Author(s): Ahmad SA, Schuricht AL. Source: Jsls. 1997 October-December; 1(4): 337-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9876699&dopt=Abstract

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What effect does the duration of an inguinal hernia have on patient symptoms? Author(s): Hair A, Paterson C, Wright D, Baxter JN, O'Dwyer PJ. Source: Journal of the American College of Surgeons. 2001 August; 193(2): 125-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11491441&dopt=Abstract

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What is the appropriate mesh for laparoscopic intraperitoneal repair of abdominal wall hernia? Author(s): Carbajo MA, Martin del Olmo JC, Blanco J. Source: Surgical Endoscopy. 2000 April; 14(4): 408, Author Reply 409-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10790566&dopt=Abstract

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When a hernia is not a hernia: the evaluation of inguinal hernias in the cirrhotic patient. Author(s): Horn TW, Harris JA, Martindale R, Gadacz T. Source: The American Surgeon. 2001 November; 67(11): 1093-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11730227&dopt=Abstract

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Where to look for the genes related to diaphragmatic hernia? Author(s): Lurie IW. Source: Genet Couns. 2003; 14(1): 75-93. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12725592&dopt=Abstract

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Who dies from hernia? Author(s): Reaveley AM, Nguyen-Van-Tam JS, Logan RF. Source: Journal of Epidemiology and Community Health. 1998 August; 52(8): 532-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9876368&dopt=Abstract

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Winston S Churchill's (1874-1965) inguinal hernia repair by Thomas P Dunhill (18761957). Author(s): Schein M, Rogers P. Source: Journal of the American College of Surgeons. 2003 August; 197(2): 313-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12892817&dopt=Abstract

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CHAPTER 2. NUTRITION AND HERNIA Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and hernia.

Finding Nutrition Studies on Hernia The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.7 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “hernia” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

7 Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

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The following information is typical of that found when using the “Full IBIDS Database” to search for “hernia” (or a synonym): ·

A new method to repair inguino-femoral hernias: laparoscopic hernioplasty. Author(s): Third Surgical Department, Semmelweis University, Medical School, Budapest, Hungary. Source: Batorfi, J Kovacs, V Sandor, J Szeberin, Z Fazekas, T Posfai, G Simon, E ActaChir-Hung. 1995-96; 35(1-2): 159-67 0231-4614

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Aneurysmal dilatation of ductus arteriosus during lipo-prostaglandin E1 therapy for diaphragmatic hernia. Author(s): Department of Paediatrics, Shinshu University, Matsumoto, Japan. Source: Tohyama, M Baba, A Tsuno, T Aonuma, K Komiyama, A Eur-J-Pediatr. 1993 November; 152(11): 877-9 0340-6199

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Colonic parastomal hernia repair by translocation without formal laparotomy. Author(s): Unitat de Cirurgia Digestiva, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Spain. Source: Botet, X Boldo, E Llaurado, J M Br-J-Surg. 1996 July; 83(7): 981 0007-1323

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Epizootics of diaphragmatic hernias in swine. Author(s): Veterinary Diagnostic Laboratory, College of Veterinary Medicine, Iowa State University, Ames 50011. Source: Schwartz, K J J-Vet-Diagn-Invest. 1991 October; 3(4): 362-4 1040-6387

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Evidence for a serotonin-mediated effect of cocaine causing vasoconstriction and herniated umbilici in chicken embryos. Author(s): Department of Pharmacology, University of Minnesota, Minneapolis 55455, USA. Source: Zhang, X Schrott, L M Sparber, S B Pharmacol-Biochem-Behavolume 1998 March; 59(3): 585-93 0091-3057

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Hiatal hernia and diaphragmatic eventration in a leopard (Panthera pardus). Author(s): Department of Comparative Medicine, College of Veterinary Medicine, University of Tennessee, Knoxville 37901-1071, USA. Source: Kearns, K S Jones, M P Bright, R M Toal, R DeNovo, R Orosz, S J-Zoo-WildlMed. 2000 September; 31(3): 379-82 1042-7260

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Laparoscopic repair of paraesophageal hiatal hernias. Author(s): Department of Surgery, University of California, San Francisco, 94143-0475, USA. Source: Gantert, W A Patti, M G Arcerito, M Feo, C Stewart, L DePinto, M Bhoyrul, S Rangel, S Tyrrell, D Fujino, Y Mulvihill, S J Way, L W J-Am-Coll-Surg. 1998 April; 186(4): 428-32; discussion 432-3 1072-7515

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Lateral repair of parastomal hernia. Author(s): Department of Surgery, Division of Coloproctology, University Hospital Nottingham, Nottingham, UK. [email protected] Source: Amin, S N Armitage, N C Abercrombie, J F Scholefield, J H Ann-R-Coll-SurgEngl. 2001 May; 83(3): 206-8 0035-8843

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Long-term outcome of medical and surgical treatment of hiatal hernias in dogs and cats: 27 cases (1978-1996). Author(s): Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville 37901-1071, USA. Source: Lorinson, D Bright, R M J-Am-Vet-Med-Assoc. 1998 August 1; 213(3): 381-4 0003-1488

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Postoperative starch granuloma revealed as femoral herniation. A case report. Author(s): Department of Pathology, Kochi Medical School, Nankoku, Japan. Source: Ohtsuki, Y Sonobe, H Takahashi, K Hayashi, K Iwata, J Ohmori, K Sanada, E Kitamoto, M Acta-Pathol-Jpn. 1988 September; 38(9): 1235-40 0001-6632

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Prenatal vitamin E treatment improves lung growth in fetal rats with congenital diaphragmatic hernia. Author(s): Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston 02114-2696, USA. Source: Islam, S Narra, V Cote, G M Manganaro, T F Donahoe, P K Schnitzer, J J JPediatr-Surg. 1999 January; 34(1): 172-6 discussion 176-7 0022-3468

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Pulmonary arterioles from rats with congenital diaphragmatic hernias are hypoplastic but not hyperresponsive. Author(s): Department of Surgery, Yale University School of Medicine, New Haven, CT, USA. Source: Au Fliegner, M Salami, S Gosche, J R J-Pediatr-Surg. 1998 September; 33(9): 1366-70 0022-3468

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Pulmonary hypertension in lambs with congenital diaphragmatic hernia: vasodilator prostaglandins, isoprenaline, and tolazoline. Author(s): Department of Paediatric Surgery, Adelaide Children's Hospital, Australia. Source: Ford, W D Sen, S Barker, A P Lee, C M J-Pediatr-Surg. 1990 May; 25(5): 487-91 0022-3468

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Regional anaesthesia for hernia repair in children: local vs caudal anaesthesia. Author(s): Department of Anaesthesia, Children's Hospital of Eastern Ontario, Ottawa, Canada. Source: Splinter, W M Bass, J Komocar, L Can-J-Anaesth. 1995 March; 42(3): 197-200 0832-610X

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Retinol status of newborn infants with congenital diaphragmatic hernia. Author(s): LIAN, Pediatric Research Unit, Laval University Hospital Center, CHUQ, 2705 Blvd. Laurier, room 2200, Sainte-FOY (Quebec) G1V 4G2, Canada. Source: Major, D Cadenas, M Fournier, L Leclerc, S Lefebvre, M Cloutier, R PediatrSurg-Int. 1998 October; 13(8): 547-9 0179-0358

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Review of the surgical management of recurrent hiatal hernia: 5-year follow-up. Author(s): Department of Surgery, Women's College Hospital, Toronto, Ont. Source: Henderson, R D Marryatt, G Henderson, R F Can-J-Surg. 1988 September; 31(5): 341-5 0008-428X

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Small bowel and mesenteric injury following traditional treatment and self-inflicted trauma to inguinal hernia. Author(s): Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. Source: Sabo, S Y Chirdan, L B East-Afr-Med-J. 1999 September; 76(9): 533-4 0012-835X

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Vitamin A decreases the incidence and severity of nitrofen-induced congenital diaphragmatic hernia in rats. Author(s): Reanimation Neonatale, Hopital Antoine Beclere, 92141 Clamart, France. Source: Thebaud, B Tibboel, D Rambaud, C Mercier, J C Bourbon, J R Dinh Xuan, A T Archer, S L Am-J-Physiol. 1999 August; 277(2 Pt 1): L423-9 0002-9513

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What is your diagnosis? Sliding hiatal hernia. Author(s): Allington Veterinary Centre, Maidstone, Kent. Source: van Dongen, P J-Small-Anim-Pract. 1997 September; 38(9): 379, 424 0022-4510

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Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: ·

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: ·

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

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Google: http://directory.google.com/Top/Health/Nutrition/

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Healthnotes: http://www.healthnotes.com/

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Open Directory Project: http://dmoz.org/Health/Nutrition/

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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

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WebMDÒHealth: http://my.webmd.com/nutrition

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

The following is a specific Web list relating to hernia; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation:

Nutrition 123

·

Food and Diet Wound Healing Source: Healthnotes, Inc.; www.healthnotes.com

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CHAPTER 3. ALTERNATIVE MEDICINE AND HERNIA Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to hernia. At the conclusion of this chapter, we will provide additional sources.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to hernia and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “hernia” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to hernia: ·

A correlation of pulmonary hypoplasia, mean airway pressure, and survival in congenital diaphragmatic hernia treated with extracorporeal membrane oxygenation. Author(s): Redmond C, Heaton J, Calix J, Graves E, Farr G, Falterman K, Arensman R. Source: Journal of Pediatric Surgery. 1987 December; 22(12): 1143-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3440901&dopt=Abstract

·

Acupuncture anaesthesia in inguinal hernia repair. Author(s): Chu DW, Lee DT, Chan TT, Chow TL, Que MB, Kwok SP. Source: Anz Journal of Surgery. 2003 March; 73(3): 125-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12608974&dopt=Abstract

·

Androgen receptors in the pelvic diaphragm muscles of dogs with and without perineal hernia. Author(s): Mann FA, Nonneman DJ, Pope ER, Boothe HW, Welshons WV, Ganjam VK.

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Source: Am J Vet Res. 1995 January; 56(1): 134-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7695142&dopt=Abstract ·

Behavioural techniques in the management of aerophagia in patients with hiatus hernia. Author(s): Calloway SP, Fonagy P, Pounder RE, Morgan MJ. Source: Journal of Psychosomatic Research. 1983; 27(6): 499-502. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6363680&dopt=Abstract

·

Diaphragmatic and abdominal hernia with cardiac complications in a dog. Author(s): WOODWARD MB. Source: J Am Vet Med Assoc. 1964 January 1; 144: 38-41. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14118010&dopt=Abstract

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Electrostimulation of healing abdominal incisional hernias by low frequency, bipolar, symmetrical rectangular pulses. An experimental study. Author(s): Franke A, Reding R, Tessmann D. Source: Acta Chir Scand. 1990 October; 156(10): 701-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2148248&dopt=Abstract

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Experimental fetal tracheal ligation and congenital diaphragmatic hernia: a pulmonary vascular morphometric analysis. Author(s): DiFiore JW, Fauza DO, Slavin R, Wilson JM. Source: Journal of Pediatric Surgery. 1995 July; 30(7): 917-23; Discussion 923-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7472945&dopt=Abstract

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Hyperbaric oxygen and high-frequency oscillator ventilation in experimental diaphragmatic hernia. Author(s): van Baren R, Heij HA, van Vugt JM, Peper JA, vd Kleij AJ, Klopper PJ. Source: Undersea & Hyperbaric Medicine : Journal of the Undersea and Hyperbaric Medical Society, Inc. 1995 September; 22(3): 315-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7580771&dopt=Abstract

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Mortality with extracorporeal membrane oxygenation following repair of congenital diaphragmatic hernia in 93 infants. Author(s): Langham MR Jr, Krummel TM, Bartlett RH, Drucker DE, Tracy TF Jr, Toomasian JM, Greenfield LJ, Salzberg AM. Source: Journal of Pediatric Surgery. 1987 December; 22(12): 1150-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3440902&dopt=Abstract

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Multiple faecal and urinary fistulae as a complication of native treatment of inguinal hernia. Author(s): Udofot SU.

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Source: Trop Geogr Med. 1991 January-April; 43(1-2): 105-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1750097&dopt=Abstract ·

Nutritional status and umbilical hernia in Nigerian school children of different ethnic groups. Author(s): Ebomoyi E, Parakoyi DB, Omonisi MK. Source: Journal of the National Medical Association. 1991 October; 83(10): 905-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1800766&dopt=Abstract

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Primary herniation of the lacrimal gland. Author(s): Soylev MF, Maden A. Source: Ophthalmic Plastic and Reconstructive Surgery. 1998 March; 14(2): 149-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9558676&dopt=Abstract

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Restoration of abdominal wall integrity as a salvage procedure in difficult recurrent abdominal wall hernias using a method of wide myofascial release. Author(s): Levine JP, Karp NS. Source: Plastic and Reconstructive Surgery. 2001 March; 107(3): 707-16; Discussion 717-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11304595&dopt=Abstract

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Small bowel and mesenteric injury following traditional treatment and self-inflicted trauma to inguinal hernia. Author(s): Sabo SY, Chirdan LB. Source: East Afr Med J. 1999 September; 76(9): 533-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10685327&dopt=Abstract

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Social, psychologic and psychophysiologic aspects of inguinal hernia. Author(s): RAHE RH, HOLMES TH. Source: Journal of Psychosomatic Research. 1965 March; 148: 487-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14279206&dopt=Abstract

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TENS after hernia repair. Author(s): Smedley F, Taube M. Source: The British Journal of Surgery. 1986 December; 73(12): 1046. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3491653&dopt=Abstract

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Thoracoscopic-assisted diaphragmatic hernia repair using a thoracic rib resection. Author(s): Malone ED, Farnsworth K, Lennox T, Tomlinson J, Sage AM. Source: Veterinary Surgery : Vs : the Official Journal of the American College of Veterinary Surgeons. 2001 March-April; 30(2): 175-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11230772&dopt=Abstract

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Transcutaneous electrical nerve stimulation for pain relief following inguinal hernia repair: a controlled trial. Author(s): Smedley F, Taube M, Wastell C. Source: European Surgical Research. Europaische Chirurgische Forschung. Recherches Chirurgicales Europeennes. 1988; 20(4): 233-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3262516&dopt=Abstract

Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: ·

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats

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Chinese Medicine: http://www.newcenturynutrition.com/

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drkoop.comÒ: http://www.drkoop.com/InteractiveMedicine/IndexC.html

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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

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Google: http://directory.google.com/Top/Health/Alternative/

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Healthnotes: http://www.healthnotes.com/

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MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine

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Open Directory Project: http://dmoz.org/Health/Alternative/

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HealthGate: http://www.tnp.com/

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WebMDÒHealth: http://my.webmd.com/drugs_and_herbs

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

The following is a specific Web list relating to hernia; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: ·

General Overview Chronic Obstructive Pulmonary Disease Source: Integrative Medicine Communications; www.drkoop.com Emphysema Source: Integrative Medicine Communications; www.drkoop.com Gastroesophageal Reflux Disease Source: Healthnotes, Inc.; www.healthnotes.com

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Hypochondriasis Source: Integrative Medicine Communications; www.drkoop.com Low Back Pain Source: Healthnotes, Inc.; www.healthnotes.com Osteoarthritis Source: Healthnotes, Inc.; www.healthnotes.com Pyloric Stenosis Source: Integrative Medicine Communications; www.drkoop.com ·

Alternative Therapy Colon Therapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,682,00.html Shiatsu Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,733,00.html Yoga Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,746,00.html

·

Chinese Medicine Huluba Alternative names: Common Fenugreek Seed; Semen Trigonellae Source: Chinese Materia Medica Juhe Alternative names: Tangerine Seed; Semen Citri Reticulatae Source: Chinese Materia Medica Lizhihe Alternative names: Lychee Seed; Semen Litchi Source: Chinese Materia Medica Qingpi Alternative names: Green Tangerine Peel; Pericarpium Citri Reticulatae Viride Source: Chinese Materia Medica Wuyao Alternative names: Combined Spicebush Root; Radix Linderae Source: Chinese Materia Medica

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Xiaohuixiang Alternative names: Fennel; Fructus Foeniculi Source: Chinese Materia Medica ·

Herbs and Supplements Chamomile Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Comfrey Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Corydalis Alternative names: Corydalis turtschaninovii, Corydalis yanhusuo Source: Healthnotes, Inc.; www.healthnotes.com Lobelia Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Matricaria Alternative names: Chamomile; Matricaria chamomilla Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Peppermint Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,812,00.html

General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.

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CHAPTER 4. DISSERTATIONS ON HERNIA Overview In this chapter, we will give you a bibliography on recent dissertations relating to hernia. We will also provide you with information on how to use the Internet to stay current on dissertations. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical dissertations that use the generic term “hernia” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on hernia, we have not necessarily excluded non-medical dissertations in this bibliography.

Dissertations on Hernia ProQuest Digital Dissertations, the largest archive of academic dissertations available, is located at the following Web address: http://wwwlib.umi.com/dissertations. From this archive, we have compiled the following list covering dissertations devoted to hernia. You will see that the information provided includes the dissertation’s title, its author, and the institution with which the author is associated. The following covers recent dissertations found when using this search procedure: ·

A Genetic Model of Congenital Diaphragmatic Hernia Created by a Null Mutation in the Slit3 Gene by Yuan, Wenlin; Phd from Washington University, 2002, 127 pages http://wwwlib.umi.com/dissertations/fullcit/3068503

·

Simulation of Preperitoneal Mesh in Laparoscopic Hernia Surgery by Sugavanam, Sivashanmugaraman; Msee from The University of Texas at Arlington, 2002, 66 pages http://wwwlib.umi.com/dissertations/fullcit/1412857

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The Changing Path of Inguinal Hernia Surgery by Berndsen, Fritz Hendrik; Phd from Lunds Universitet (sweden), 2003, 112 pages http://wwwlib.umi.com/dissertations/fullcit/f148417

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Keeping Current Ask the medical librarian at your library if it has full and unlimited access to the ProQuest Digital Dissertations database. From the library, you should be able to do more complete searches via http://wwwlib.umi.com/dissertations.

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CHAPTER 5. CLINICAL TRIALS AND HERNIA Overview In this chapter, we will show you how to keep informed of the latest clinical trials concerning hernia.

Recent Trials on Hernia The following is a list of recent trials dedicated to hernia.8 Further information on a trial is available at the Web site indicated. ·

Spine Patient Outcomes Research Trial- Intervertebral Disc Herniation Condition(s): Herniated Disc; Low Back Pain Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); National Institute for Occupational Safety and Health (NIOSH/CDC); Office of Research on Women's Health (ORWH) Purpose - Excerpt: This study tests the effectiveness of different treatments for the three most commonly diagnosed lumbar (lower) spine conditions. The purpose of the study is to learn which of two commonly prescribed treatments (surgery and non-surgical therapy) works better for specific types of low back pain. In this part of the study, people with lumbar intervertebral disc herniation (damage to the tissue between the bones of the lower spine, or backbone) will receive either discectomy (surgical removal of herniated disc material) or non-surgical treatment. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00000410

8

These are listed at www.ClinicalTrials.gov.

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·

Does Tension-Free Herniorrhaphy or Laparoscopic Herniorrhaphy Achieve Equal or Better Recurrence Rates and Lower Costs While Achieving Equivalent Outcomes for Hernia Patients? Condition(s): Hernia Study Status: This study is no longer recruiting patients. Sponsor(s): Department of Veterans Affairs; Department of Veterans Affairs Cooperative Studies Program; American College of Surgeons Purpose - Excerpt: Inguinal hernia is one of the most common worldwide afflictions of men. The presence of an inguinal hernia is indication for its repair. Approximately 700,000 hernia repairs are performed in the U.S. each year, and this procedure accounts for 10% of all general surgery procedures in the Veterans Health Administration (VHA) (10,000 inguinal herniorrhaphies performed per year). There are many different techniques currently in use for repairing inguinal hernias and with the advent of laparoscopy, yet another technique is being advocated. Laparoscopic repair has been reported in some studies to be superior to open repair because of less pain and earlier return to work. However, laparoscopic repair requires a general or regional anesthetic and expensive equipment and supplies to perform. There is also evidence that open tension-free mesh repair may have results similar to laparoscopic repair for these patient centered outcome measures. The general acceptance of this procedure, especially in the VHA, has not been uniform. Furthermore, no randomized trial of sufficient size and power to be conclusive has been done to set forth the operative "gold standard" for hernia repair. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00032448

Keeping Current on Clinical Trials The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to the Web site at http://www.clinicaltrials.gov/ and search by “hernia” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: ·

For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/

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·

For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html

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For cancer trials, visit the National Cancer Institute: http://cancertrials.nci.nih.gov/

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For eye-related trials, visit and search the Web page of the National Eye Institute: http://www.nei.nih.gov/neitrials/index.htm

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For heart, lung and blood trials, visit the Web page of the National Heart, Lung and Blood Institute: http://www.nhlbi.nih.gov/studies/index.htm

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For trials on aging, visit and search the Web site of the National Institute on Aging: http://www.grc.nia.nih.gov/studies/index.htm

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For rare diseases, visit and search the Web site sponsored by the Office of Rare Diseases: http://ord.aspensys.com/asp/resources/rsch_trials.asp

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For alcoholism, visit the National Institute on Alcohol Abuse and Alcoholism: http://www.niaaa.nih.gov/intramural/Web_dicbr_hp/particip.htm

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For trials on infectious, immune, and allergic diseases, visit the site of the National Institute of Allergy and Infectious Diseases: http://www.niaid.nih.gov/clintrials/

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For trials on arthritis, musculoskeletal and skin diseases, visit newly revised site of the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health: http://www.niams.nih.gov/hi/studies/index.htm

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For hearing-related trials, visit the National Institute on Deafness and Other Communication Disorders: http://www.nidcd.nih.gov/health/clinical/index.htm

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For trials on diseases of the digestive system and kidneys, and diabetes, visit the National Institute of Diabetes and Digestive and Kidney Diseases: http://www.niddk.nih.gov/patient/patient.htm

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For drug abuse trials, visit and search the Web site sponsored by the National Institute on Drug Abuse: http://www.nida.nih.gov/CTN/Index.htm

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For trials on mental disorders, visit and search the Web site of the National Institute of Mental Health: http://www.nimh.nih.gov/studies/index.cfm

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For trials on neurological disorders and stroke, visit and search the Web site sponsored by the National Institute of Neurological Disorders and Stroke of the NIH: http://www.ninds.nih.gov/funding/funding_opportunities.htm#Clinical_Trials

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CHAPTER 6. PATENTS ON HERNIA Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.9 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “hernia” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on hernia, we have not necessarily excluded non-medical patents in this bibliography.

Patents on Hernia By performing a patent search focusing on hernia, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We

9Adapted from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.

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will tell you how to obtain this information later in the chapter. The following is an example of the type of information that you can expect to obtain from a patent search on hernia: ·

Anatomical prosthesis for the repair of hernias by a laparoscopic or open route Inventor(s): Benchetrit; Salomon (Caluire, FR) Assignee(s): Sofradim Production (Trevoux, FR) Patent Number: 6,066,777 Date filed: October 20, 1997 Abstract: The invention relates to an anatomical prosthesis adapted specially for the inguinal region and intended for the repair of inguinal hernias, especially by a laparoscopic route. It comprises a first and a second plate, each comprising a porous and flexible prosthetic material, and these being connected to one another along a connection line by a connection means. The two plates are asymmetrical in relation to one another, and, in a deployed configuration of the prosthesis, the second plate has at least one undulated developed shape, and anatomical so as to match the general shape of the lower inguinal structures, and correspondingly the connection line has at least one undulated curved shape, the generatrix describing this developed shape and passing through the connection line being directed at an aperture angle.theta. at most equal to 150.degree. relative to the plane of the first plate. Excerpt(s): The present invention relates to an anatomical prosthesis for the repair of hernias, and in particular a prosthesis adapted for the repair of inguinal hernias by laparoscopy. In a general manner, prostheses for the repair of the inguinal region and for the treatment of hernias are well known, and consist in particular of one or more porous prosthetic plates, made of a biocompatible synthetic material, which may or may not be absorbable, for example polyethylene, polypropylene, polyester, or similar, optionally having undergone a surface treatment to render it biocompatible with the cellular medium in which they are implanted. These prostheses can be obtained, for example, by joining together two plates of prosthetic material by knitting. Such a prosthesis has been described in the American patent U.S. Pat. No. 4,769,038, granted to Bendavid et al., this prosthesis being designed essentially for the complete reconstruction of the inguinal region. In accordance with this patent, the prosthesis comprises a first plate, being a substantially plane upper plate, and a second plate, being a lower plate, the plates each comprising a porous and flexible prosthetic material. These plates of generally elongate shape are connected to one another along a straight connection line by a connection means, for example a seam. The prosthesis additionally comprises a third plate which is connected to the two others along the same straight connection line, and by the same seam. Web site: http://www.delphion.com/details?pn=US06066777__

·

Anti-reflux/heartburn device Inventor(s): Heller; Brian (15 Abington Square, Apt. #26, New York, NY 10014) Assignee(s): none reported Patent Number: 6,274,786 Date filed: April 27, 1998

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Abstract: The device has a protrusion maintaining sustained pressure to an area of the upper abdomen. This mechanical pressure serves to assist in closing the cardiac sphincted, help induce esophageal relaxation and, in the case of a hiatal hernia, to return the stomach to the correct anatomical position. The device is semirigid to allow the device to apply pressure to the user without being pushed outwardly. Excerpt(s): Many people suffer from gastroesophageal reflux disorder (GERD). Gastroesophageal reflux disorder is a reflux, or backward or return flow, of fluid of gastric or intestinal contents into the esophagus. Heartburn is a symptom of this disorder. This condition arises when the lower esophageal sphincter, between the stomach and esophagus, becomes lax or spastic. This allows gastric acid to move from the stomach into the esophagus. The gastric juices irritate the esophagus lining. Possible causes of the disorder include scleroderma, pregnancy, improper diet, autoimmune disorders or a hiatal hernia. Treatment for this disorder typically includes a change in diet and the use of non-prescription antacids or prescription medications. Severe cases may require anti-reflux surgery. Recurrence is common. Web site: http://www.delphion.com/details?pn=US06274786__ ·

Apparatus and method for dissecting tissue layers Inventor(s): Mollenauer; Kenneth H. (Los Gatos, CA), Howell; Thomas A. (Palo Alto, CA), Kieturakis; Maciej J. (San Carlos, CA), Kayan; Helmut (Redwood City, CA), Echeverry; Jan M. (San Jose, CA), Robinson; Janine C. (Half Moon Bay, CA), Jervis; James E. (Atherton, CA) Assignee(s): General Surgical Innovations, Inc. (Norwalk, CT) Patent Number: 6,540,764 Date filed: January 6, 1999 Abstract: An expansible tunneling apparatus and assosiated methods for creating an anatomic working space for a surgical procedure such as a hernia repair. Various embodiments of one and two piece apparatus that permit laparoscopic observation both during tunneling and during subsequent balloon dissection are disclosed. In a disclosed one piece embodiment, a tubular member has a bore extending therethrough and an open distal end. A lip is formed in the distal end of the tubular member to capture the distal tip of a laparoscope that is inserted into the tubular member to permit observation of the procedure both during tunneling to a desired location and during subsequent balloon inflation. An elongated neck of the balloon is secured to the tunneling member. The elongated neck permits the tubular member to be withdrawn slightly from the balloon after inflation to facilitate observation. After the balloon has been advanced to the desired location in the body it is inflated through a balloon inflation lumen to cause the balloon to dissect tissue and create an operating space. The operating space may then be insulated with gas to form a working space for repairing a hernia. Excerpt(s): This invention relates generally to an apparatus and method for developing an anatomic space for laparoscopic procedures, and more specifically, to an apparatus and method that provides for laparoscopic visualization both during tunneling dissection to the desired anatomic space as well as during subsequent tissue dissection during balloon inflation once the desired potential space has been identified. In the past, in developing spaces and potential spaces within a body, blunt dissectors or soft-tipped dissectors have been utilized to create a dissected space which is parallel to the plane in which the dissectors are introduced into the body tissue. This often may be in an

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undesired plane, which can lead to bleeding which may obscure the field and make it difficult to identify the body structures. In utilizing such apparatus and methods, attempts have been made to develop anatomic spaces in the anterior, posterior or lateral to the peritoneum. The same is true for pleural spaces and other anatomic spaces. Procedures that have been performed in such spaces include varicocele dissection, lymph node dissection, sympathectomy and hernia repair. In the past, the inguinal hernia repair has principally been accomplished by the use of an open procedure which involves an incision in the groin to expose the defect in the inguinal floor, removal of the hernial sac and subsequent suturing the ligaments and fascias together to reinforce the weakness in the abdominal wall. Recently, laparoscopic hernia repairs have been attempted by inserting laparoscopic instruments into the abdominal cavity through the peritoneum and then placing a mesh patch over the hernia defect. Hernia repair using this procedure has a number of disadvantages, principally because the mesh used for the hernia repair is in direct contact with the structures in the abdominal cavity, as for example the intestines, there is a tendency for adhesions to form between these structures. Such adhesions are known to be responsible for certain occasionally serious complications. Such a procedure is also undesirable because typically the patch is stapled to the peritoneum, which is a very thin unstable layer covering the inner abdomen. Thus, the stapled patch can tear away from the peritoneum or shift its position. Other laparoscopic approaches involve cutting away the peritoneum and stapling it closed. This is time consuming, however, and involves the risk that important anatomic structures may be inadvertently cut. In addition, such a procedure is undesirable because it requires the use of a general anesthesia. There is therefore a need for a new and improved apparatus and method for developing an anatomic space and particularly for accomplishing hernia repair by laparoscopy. In general, it is an object of the present invention to provide an apparatus and method for developing an anatomic space. Web site: http://www.delphion.com/details?pn=US06540764__ ·

Apparatus for the installation of a prosthesis in the treatment of inguinal hernias via the peritoneoscopic route Inventor(s): Cancel; Richard (317, rue Olive Tamari, F-83130 La Garde, FR), Wallace; Richard (18, rue du Paradis, F-83400 Hyeres, FR), Sassi; Gerard (105, boulevard Coste Chaude, F-83200 Toulon, FR) Assignee(s): none reported Patent Number: 6,428,546 Date filed: May 26, 2000 Abstract: The invention provides an apparatus enabling the introduction of a prosthesis of the pad form with increased ease into the interior of the abdominal cavity and to automatically unroll it, such that its installation and stapling are easier for the practitioner. More specifically, the invention includes a device for the installation of a prosthesis in the treatment of inguinal hernias via peritoneoscopy, including an applicator essentially constituted of a substantially cylindrical tube capable of containing the prosthesis, a plunger for injecting the prosthesis from the tube at the desired site, and a spring attached to the plunger such that it is capable of attaching to the prosthesis in a detachable manner and of spreading it out when it is discharged to the exterior of the tube.

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Excerpt(s): This invention pertains to the treatment of inguinal hernias via the peritoneoscopic route. More specifically, the invention relates to apparatus for the installation of a prosthesis in the abdominal cavity in the implementation of this treatment. Inguinal hernias result from the passage of intra-abdominal organs to the outside of the abdominal cavity, passing through the muscular wall. This abnormal passage stems from a defect which can be congenital or acquired. Inguinal hernias are very common disorders, such that surgical interventions for repairing these defects are at present among the most frequently performed operations. There are two problems related to the repair of inguinal hernias: their frequency and the rate of recidivism after treatment. An imperfect operative technique results in a high recidivism rate with the associated human and social consequences (repeated surgical interventions, increased costs). Web site: http://www.delphion.com/details?pn=US06428546__ ·

Balloon device for use in surgery and method of use Inventor(s): Echeverry; Jan M. (San Jose, CA), Jervis; James E. (Atherton, CA) Assignee(s): General Surgical Innovations, Inc. (Norwalk, CT) Patent Number: 6,565,589 Date filed: September 5, 1997 Abstract: A balloon device useful for dissecting tissue or retracting tissue for the purpose of providing space for laparoscopic surgery comprising a balloon having at least two protuberances in its distal region. The present device is particularly useful in bladder neck suspension and hernia repair procedures. Excerpt(s): The present invention constitutes specially shaped balloon dissection or retraction devices and their use. The invention relates generally to an apparatus and method for developing an anatomic space for laparoscopic procedures and, more specifically, to an apparatus and method particularly suitable for surgical procedures in which there is a need to dissect around an obstruction or around an area which it would be undesirable to dissect. The present invention provides a device which can be used to dissect around a hernia and in bladder neck suspension procedures, also known as urethropoxy, in which avoidance of the pubic symphysis is desirable. The present invention comprises a balloon suitable for tissue dissection or tissue retraction which has at least two protuberances (which may be referred to as "legs", "arms", "horns" or other descriptive term) at its distal region and its method of use. These protuberances may be relatively large relative to the remainder of the balloon or they may be relatively small, depending upon the anatomy of the region in which the balloon is to be used. The purpose of the protuberances is to achieve dissection in the desired location and to avoid dissection where it would be detrimental to the patient. Web site: http://www.delphion.com/details?pn=US06565589__

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Curved prosthetic mesh and its method of manufacture Inventor(s): Coddaire; John W. (North Chelmsford, MA), Herzog; Fred D. (Westford, MA), Pajotin; Docteur Philippe (Cholet, FR) Assignee(s): C.R. Bard Inc. (Murray Hill, NJ) Patent Number: 5,954,767 Date filed: July 24, 1996 Abstract: A prothesis is provided for repairing a defect in a muscle or tissue wall. The prothesis has a preformed shape that conforms to the wall to facilitate placement and minimize shifting of the prothesis when positioned on the wall. The prosthesis may include a body formed of a sheet of surgical mesh fabric having a flexible inner portion surrounded by a stiffer periphery that is capable of resuming the preformed shape after being temporarily deformed to allow for implantation. The body may include a tapered end to facilitate insertion of the prothesis between the parietal peritoneum and the abdominopelvic wall during hernia repairs. The body may also include a curved end to permit repositioning of the bladder after implantation. In one embodiment, the prothesis includes a conical portion at the tapered end and a spherical portion at the curved end. The body may also include a permanent depression on a surface that receives the iliac vessels when the prothesis is positioned on the wall to repair an inguinal hernia. Excerpt(s): The present invention relates to prosthetic meshes and their methods of manufacture. The prior art includes a prosthetic mesh made of an implantable, nonresorbable, flexible material, designed to be implanted for the parietal repair of hernias and eventrations of the abdominal wall. These meshes, which are usually made of implantable polypropylene, preferably have tight mesh openings and are obtained by knitting, welding or weaving. They are supplied to surgeons pre-cut, in the form of a flat element. However, this flat element must be applied to a concave surface by the surgeon. As a result of the difference in conformation, the mesh is difficult to put into position, especially since one of its relatively broad margins has to be slipped between the parietal peritoneium and the abdominopelvic wall. Moreover, as it is being put in place, the mesh folds or wrinkles and is hard to keep in place at the point where many surgeons prefer to attach it. Its inner margin corresponding to the other small side must be slipped between the bladder and the abdominopelvic wall. A straight margin is poorly suited for insertion of the internal edge. The invention palliates these disadvantages by means of a mesh which is easier to put in place and which, once in position, has virtually no tendency to shift, without the need for any additional intervention such as fixation, thereby making it possible to reinforce all the weak points of the inguinofemoral region, resulting in a much lower failure rate than heretofore. Web site: http://www.delphion.com/details?pn=US05954767__

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Deployment apparatus for supple surgical materials Inventor(s): Rousseau; Robert A. (Ottsville, PA) Assignee(s): Ethicon, Inc. (Somerville, NJ) Patent Number: 6,575,988 Date filed: May 15, 2001

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Abstract: A hernia prosthesis deployment device includes an elongated rod through which a drawstring extends forming a loop at the distal end. The size of the loop is controlled by pulling on an end of the drawstring extending from the proximal end of the rod. A plurality of independent segments are threaded onto the drawstring loop in bead-like fashion, such that when the loop is expanded, the loop with segments is flexible. When the loop is contracted, the segments force the loop into a planar configuration. A surgical patch is attached to the loop such that it can be folded and pushed into position in the body. Thereafter, the loop is contracted by pulling the drawstring forcing the loop and attached patch into a planar configuration to cover the defect to be repaired. Excerpt(s): The present invention relates to an apparatus for placing and deploying supple surgical materials such as surgical mesh within the body, and more particularly to a substantially planar surgical mesh prosthesis for bridging a hernia and an apparatus for placing and deploying the prosthesis. Modern surgical techniques are intended to be minimally invasive. Endoscopic surgery is a prime example of this minimally invasive approach and has led to the development of various instruments that may be inserted through a small incision to operate internally. In some circumstances, such as with specimen retrieval pouches or organ pouches and bags, the surgical instrument places, controls and/or deploys a supple material, e.g., a latex bag. The supple material may assume folded, expanded and contracted states, e.g., for inserting, opening and closing within the body. Accordingly, various apparatus have been devised to accomplish these transitions and functions relative to supple surgical materials like latex sheeting and textiles, but these apparatus are frequently complex, expensive and utilize exotic materials. Minimally invasive procedures are also commonly employed in the treatment of hernias, e.g., in the placement of mesh surgical prostheses. Surgically implantable mesh patches for the repair of inguinal and other abdominal wall hernias are commonly used and provide tension-free repairs by bridging the hernia defect. Patches of this type constitute a structural support which decreases recurrence rates and because they do not require the displacement of tissues to cover the hernia, decrease postoperative discomfort. Frequently, prostheses of this type are sutured in place, i.e., proximate to the periphery of the patch. An alternative to suturing the prosthesis is to insert it into the properitoneal space. U.S. Pat. No. 5,916,225 to Kugel discloses a hernia prosthesis having a resilient ring made of synthetic material, such as nylon, polypropylene or polyester enclosed within a pocket formed by opposing planar segments of surgical mesh that are attached together to encapsulate the ring. A slit is provided in one of the planar segments to permit the surgeon to insert a finger therein in order to push the prosthesis through an incision in the abdominal wall into the properitoneal space and across the hernia. The resilient ring urges the pocket into a deployed planar configuration, i.e., to straighten the wrinkling and folding of the pocket that occurs in the course of its placement. The disadvantages associated with the device disclosed in U.S. Pat. No. 5,916,225 are that each layer of mesh is stiff and dense, such that the combination of two layers and the resilient ring constitutes a rigid, high mass prosthesis which tends to cause discomfort and resists conformance to the patient's anatomy. Further, the high mass prosthesis with resilient ring must be compressed into a stressed condition in order to be passed through the incision. Alternatively, the incision must be made large enough to pass the fully expanded prosthesis. Web site: http://www.delphion.com/details?pn=US06575988__

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Fastener for hernia mesh fixation Inventor(s): Fuchs; Richard P. (Cincinnati, OH), Ludzack; Michael R. (Maineville, OH), Knodel; Bryan D. (Flagstaff, AZ) Assignee(s): Ethicon Endo-Surgery, Inc. (Cincinnati, OH) Patent Number: 6,447,524 Date filed: October 19, 2000 Abstract: A surgical fastener for attaching a prosthesis to body tissue formed from a generally planar continuous body member. The body has a proximal end, a distal end and a longitudinal axis therebetween. The body is preferably made from a superelastic nickel titanium alloy. The device further includes at least one, but preferably two, resilient barbs extending proximally and axially away from the distal end, preferably in different directions. The device further includes and at least one, but preferably two, resilient legs extending proximally and axially away from the proximal end, preferably in different directions. The barbs and the legs are also preferably made from a superelastic nickel titanium alloy. Excerpt(s): The present invention relates, in general, to a surgical fastener and, more particularly, to a surgical fastener for attaching a prosthetic in the repair of a defect in tissue such as an inguinal hernia. An inguinal hernia is a condition where a small loop of bowel or intestine protrudes through a weak place or defect within the lower abdominal muscle wall or groin of a patient. This condition commonly occurs in humans, particularly males. Hernias of this type can be a congenital defect wherein the patient is born with this problem, or can be caused by straining or lifting heavy objects. Heavy lifting is known to create a large amount of stress upon the abdominal wall and can cause a rupture or tearing at a weak point of the abdominal muscle to create the defect or opening. In any case, the patient can be left with an unsightly bulge of intestinal tissue protruding through the defect, pain, reduced lifting abilities, and in some cases, impaction of the bowel, or possibly other complications if the flow of blood is cut off to the protruding tissue. A common solution to this problem is surgery. In the surgical procedure, the defect is accessed and carefully examined, either through an open incision or endoscopically through an access port such as a trocar. In either case, the careful examination can be well appreciated, as a network of vessels and nerves exist in the area of a typical defect, which requires a surgeon to conduct a hernia repair with great skill and caution. Within this area are found vascular structures such as gastric vessels, the external iliac vessels, and the inferior epigastric vessels, and reproductive vessels such as the vas deferens extending through the inguinal floor. Web site: http://www.delphion.com/details?pn=US06447524__

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Flexible implant Inventor(s): Knopf; Wieland (Georgenthal, DE), Landgrebe; Susanne (Norderstdt, DE) Assignee(s): Ethicon, Inc. (Somerville, NJ) Patent Number: 5,919,233 Date filed: June 25, 1997 Abstract: A flexible implant (1) with a cylinder-like basic form has near its first end (2) an eye-like opening (3), the axis (4) of which runs transversely to the cylinder axis. The implant (1) can be closed to a ring form by guiding the second end (6) through the

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opening (3), and is thus suitable in particular for the treatment of reflux oesophagitis and/or axial hiatus hernia. Excerpt(s): The invention relates to a flexible implant, in particular for the treatment of reflux oesophagitis and/or axial hiatus hernia. Described in European Patent No. 0 061 540 is a prosthesis also known under the name ANGELCHIK anti-reflux prosthesis which is used for the treatment of reflux oesophagitis. It is essentially a C-shaped cushion element, preferably of silicon, at the two ends of which is attached a flexible strip in each case. In a surgical operation this prosthesis is placed around the distal region of the gullet (oesophagus), above the cardiac orifice (cardia) and below the midriff (diaphragm). When the C-shaped part encloses the oesophagus, the two flexible strips are knotted together. In this way a ring forms which prevents a rising of stomach parts into the thorax area in the case of an axial hiatus hernia, and simultaneously reduces a reflux of the stomach contents into the distal area of the oesophagus. The previously-known anti-reflux prosthesis cannot be inserted into the abdominal cavity via a cannula (trocar sleeve); a laparotomy is required for this. Only the positioning and the knotting of the two flexible strips are possible endoscopically, something which does, however, require much skill from the operator. Web site: http://www.delphion.com/details?pn=US05919233__ ·

Flexible prosthesis in particular for curing hernias by colioscopy Inventor(s): Lecalve; Jean-Luc (Rennes, FR) Assignee(s): Ethicon (Issy-les-Moulineaux, FR) Patent Number: 6,517,584 Date filed: February 5, 2001 Abstract: A flexible prosthesis, in particular for curing hernias by colioscopy, the prosthesis including at least one anchor, device made of shape memory material designed to be deformed merely under temperature control from a storage position into a fixing position in which the anchor device interferes with the surrounding tissue. Excerpt(s): The present invention relates to the field of prostheses made of flexible cloth. It applies in particular to prostheses designed to be into place by endoscopic surgery. More precisely still, the present invention applies preferably to fixing the flexible prostheses defined in document FR-A-2 710 518. The means defined in that document are designed mainly for curing hernias by colioscopy using a precut web which is put into place by laparoscopy. Web site: http://www.delphion.com/details?pn=US06517584__

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Hernia belt Inventor(s): Greene; Nicole D. (Weston, FL), Slautterback; Ernest Gerald (Coral Springs, FL), Machin; Rhonda M. (Weston, FL) Assignee(s): FLA Orthopedics, Inc. (Miramar, FL) Patent Number: 6,422,242 Date filed: August 21, 2000

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Abstract: A hernia belt which is provided in two parts, comprising an abdominal belt portion, having a pair of leg straps which extend downwardly for passing between the legs of a wearer, and a separate back belt portion, which extends around the back of the wearer. Virtually the entire face of the exterior of the abdominal belt portion is formed of hook or loop material, which engages with mating loop/hook surfaces on the ends of the back belt portion. The combination of the abdominal belt portion having virtually its entire surface covered with hook/loop material, and a back belt portion with hook/loop material at its ends, makes it possible to provide virtually universal or "fits all" hernia support. Excerpt(s): The present invention is directed to a hernia belt or truss useful in supporting abdominal hernias. Hernia belts have been well known for many years and have been proposed and used in many different forms. Examples of some of these differing devices are reflected in the patent literature. U.S. Pat. No. 4,059,103, issued Nov. 22, 1977, to Glaser, describes a one-piece bi-sexual garment. A narrow neck section of the support passes through the crotch of the wearer and anchors the bottom part, while a first belt like elastic band connects and supports the upper parts of the front and rear sections, and is secured to both. A second belt-like elastic band encircles the hips of the wearer below the first elastic band, and is fastened only to the rear portion of the support. The elastic bands extend over the hips to provide up-lift. Web site: http://www.delphion.com/details?pn=US06422242__ ·

Hernia brief Inventor(s): Slautterback; Ernest Gerald (Coral Springs, FL), Bozza; Daniel J. (Coral Springs, FL), Miller; Jennifer L. (Plantation, FL), Machin; Rhonda M. (Weston, FL) Assignee(s): FLA Orthopedics, Inc. () Patent Number: 6,622,719 Date filed: November 12, 2002 Abstract: Disclosed is an improved hernia device which includes an undergarment brief having front, side, rear and crotch portions defining spaced leg openings wherein the front portion has one or two truss pads supported from its inner surface to protrude inwardly of the brief to engage and support abdominal hernia areas of the body of a wearer; with the truss pads independently held in position and urged toward the body of the wearer by a pair of straps having inner ends secured to the center of the front portion and extending in opposite directions with distal ends independently and adjustably secured to side portions forward of opposite lateral side centers of the hips of the wearer. Also disclosed is the use of a two piece seat or rear panel having a heavier upper portion of heavier material which assists in providing back support while carrying and distributing tension which may be transferred by the tension straps. A further feature of the device is the provision the convenience of dual toilet access openings from said crotch portion. Excerpt(s): This invention relates to hernia supports or trusses, and in particular, to a combination brief or undergarment and hernia support which provides both support and comfort to a wearer. U.S. Pat. No. 4,416,272, issued Nov. 22, 1983 to Nelkin, describes a combination underpant and hernia truss which comprises a brief having front, rear and crotch portions with spaced leg holes and a waist opening having a waist band. A truss pad is attached to the front portion and protrudes inwardly of the brief to engage and support a herniated abdominal area. An adjustable length belt encircles the

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brief and the wearer, and is connected to the center of the front portion of the brief adjacent the pad, for directing hernia retaining force on the pad. Provision is made for both left and right truss pads. The encircling belt is free from securement to other portions of the brief and may be moved and positioned upwardly and downwardly by the wearer. The device thus constitutes in essence a complete brief in addition to a largely separate hernia belt. The belt encircles the body of the wearer with the loose belt ends being fastened together at the wearer's back. When it is thus secured, its diameter forms in effect a second waistband which tends to cause discomfort while at the same time providing a limited nature and degree of hernia retaining support adjustability. U.S. Pat. No. 4,671,264, issued Jun. 9, 1987, to Frangi, describes an underpant brief and hernia truss. An elastic belt is disposed at the circumferential upper edge of the brief, and a pair of at least partly elastic bands has upper ends which are affixed to the elastic belt and pass laterally of the crotch of the pant, adjacent the leg holes of the brief. These bands include an inelastic segment on the front of the underpant extending diagonally across hernia affected regions of the wearer. Pockets are included over the hernia affected region for receiving a retaining pad. The assembled and finished garment is essentially an integrated one piece garment. The dimensions and securements of the sewn together layers are fixed at the time of manufacture, whereby the fit and support provided by the garment are not susceptible of user adjustment. Web site: http://www.delphion.com/details?pn=US06622719__ ·

Hernia mesh Inventor(s): Antikainen; Teuvo (Jyvaskyla, FI), Tormala; Pertti (Tampere, FI), Paasimaa; Senja (Tampere, FI) Assignee(s): Bionx Implants Oy (Tampere, FI) Patent Number: 6,319,264 Date filed: April 3, 1998 Abstract: According to the present invention, a flexible, fibrous hernia mesh is provided, which is intended to be implanted to close hernia defects. The mesh has at least two functional components or layers: (1) a rapidly degradable first layer and (2) a more slowly degradable (with respect to the first layer) second layer. Using the fibrous mesh of this invention, the hernia defect can be closed so that a) the second layer supports the area until the scar tissue is strong enough (around 6 months), to prevent recurrent hernia formation, b) while the more rapid degradation of the first layer induces scar tissue formation due to inflammatory reaction, and c) the second layer isolates the first layer from the abdominal cavity, preventing tissue to tissue adhesion onto the intestines. The mesh is placed on the uncovered fascia area with its more rapidly absorbable side (the first layer) towards the fascia. Excerpt(s): The present invention relates to a biologically active hernia mesh, and methods of its manufacture. Traditionally, a hernia bulging through any region of the abdominal wall would be repaired by an open hernioplasty and based on a method where the hernia defect becomes closed and reinforced by adjacent tissues. In cases of very large or recurrent hernias, meshes of some nonabsorbable synthetic material have been used for repair. During a period of 3 to 6 months following the hernia operation, the repaired site gradually gathers scar tissue which builds up to strengthen the region. The new trends for hernia repair include mini-invasive techniques, in which the hernia defect is closed by a piece of non-absorbable mesh with minimal tension. The follow-up times thus far are short for such procedures, but it seems that recurrence rates of 1% or

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below could be expected. Also, the general recovery time has become shorter, and the patients are usually encouraged to begin their normal activities with no restrictions within a week after the operation. Web site: http://www.delphion.com/details?pn=US06319264__ ·

Hernia mesh patch Inventor(s): Kugel; Robert D. (Olympia, WA), Kugel; Robert D. (Olympia, WA) Assignee(s): Bard ASDI Inc. (Murray Hill, NJ), Bard ASDI Inc. (Murray Hill, NJ) Patent Number: 6,224,616 Date filed: May 4, 1999 Abstract: A method for repairing a hernia uses a mesh patch for permanent placement within a patient's body space. The patch has top and bottom mesh layers secured to each other with a seam. The seam surrounds and defines a pocket. The top layer has a transverse slit opening into the pocket. To serve a spring function, an implantable loop is inserted into the pocket to keep the patch expanded under tension in a planar configuration. A border on at least one of the layers extends outward past the seam. The border preferably has slits to fill uneven voids in the patient's tissue and fit more tightly. A surgeon makes a small incision in the patient and performs a dissection deep into the patient's preperitoneal space, creating a pocket in this space into which the patch is to be inserted. The patch is folded and directed into the patient's preperitoneal space, where it is unfolded and expanded into its planar configuration to cover the defect in the patient. Thereafter the surgeon secures the incision with stitches. Excerpt(s): Surgically implantable mesh patches for the repair of inguinal and other abdominal wall hernias, which are intended for permanent placement within a patient's body space, have been provided and used previously. Tension free surgical repairs of hernias have been developed using-synthetic mesh materials to bridge and to patch hernia defects. These repairs resulted in both a decrease in the recurrence rate as well as a decrease in the amount of a patient's post operative discomfort. Patients undergoing these more advanced procedures were able and are able to resume their normal activities sooner. Surgically implantable mesh patches for the repair of inguinal and other abdominal wall hernias, which are intended for permanent placement within a patient's body space, have been provided and used previously. Tension free surgical repairs of hernias have been developed using-synthetic mesh materials to bridge and to patch hernia defects. These repairs resulted in both a decrease in the recurrence rate as well as a decrease in the amount of a patient's post operative discomfort. Patients undergoing these more advanced procedures were able and are able to resume their normal activities sooner. Some of these earlier techniques are somewhat complicated. Several use a plug or a locating member to fit within the hernia defect itself. Also many of these earlier techniques were designed specifically for use in laparoscopic repair of hernias. Moreover, many of the prior inventions required suturing to the patient's body tissue. Although these medical advances are acknowledged for their usefulness and success, there remained a need or needs for more improvements in the surgical repair of hernias. Some of these earlier techniques are somewhat complicated. Several use a plug or a locating member to fit within the hernia defect itself. Also many of these earlier techniques were designed specifically for use in laparoscopic repair of hernias. Moreover, many of the prior inventions required suturing to the patient's body tissue. Although these medical advances are acknowledged for their usefulness and success, there remained a need or needs for more improvements in the surgical repair of hernias.

Patents 149

A hernia mesh patch for use in the surgical repair of a patient's inguinal, or other abdominal wall hernias, is disclosed for permanent placement within a patient's body space. This hernia mesh patch has top and bottom layers of an inert, synthetic mesh, preferably polypropylene mesh, secured to each other with a seam. The seam surrounds and defines a pocket. The top layer has a transverse cut or slit opening into the interior pocket or pouch volume of this patch. A hernia mesh patch for use in the surgical repair of a patient's inguinal, or other abdominal wall hernias, is disclosed for permanent placement within a patient's body space. This hernia mesh patch has top and bottom layers of an inert, synthetic mesh, preferably polypropylene mesh, secured to each other with a seam. The seam surrounds and defines a pocket. The top layer has a transverse cut or slit opening into the interior pocket or pouch volume of this patch. Web site: http://www.delphion.com/details?pn=US06224616__ ·

Hernia mesh patch Inventor(s): Kugel; Robert D. (Olympia, WA), Kugel; Robert D. (Olympia, WA) Assignee(s): Bard ASDI Inc. (Murray Hill, NJ), Bard ASDI Inc. (Murray Hill, NJ) Patent Number: 6,224,616 Date filed: May 4, 1999 Abstract: A method for repairing a hernia uses a mesh patch for permanent placement within a patient's body space. The patch has top and bottom mesh layers secured to each other with a seam. The seam surrounds and defines a pocket. The top layer has a transverse slit opening into the pocket. To serve a spring function, an implantable loop is inserted into the pocket to keep the patch expanded under tension in a planar configuration. A border on at least one of the layers extends outward past the seam. The border preferably has slits to fill uneven voids in the patient's tissue and fit more tightly. A surgeon makes a small incision in the patient and performs a dissection deep into the patient's preperitoneal space, creating a pocket in this space into which the patch is to be inserted. The patch is folded and directed into the patient's preperitoneal space, where it is unfolded and expanded into its planar configuration to cover the defect in the patient. Thereafter the surgeon secures the incision with stitches. Excerpt(s): Surgically implantable mesh patches for the repair of inguinal and other abdominal wall hernias, which are intended for permanent placement within a patient's body space, have been provided and used previously. Tension free surgical repairs of hernias have been developed using-synthetic mesh materials to bridge and to patch hernia defects. These repairs resulted in both a decrease in the recurrence rate as well as a decrease in the amount of a patient's post operative discomfort. Patients undergoing these more advanced procedures were able and are able to resume their normal activities sooner. Surgically implantable mesh patches for the repair of inguinal and other abdominal wall hernias, which are intended for permanent placement within a patient's body space, have been provided and used previously. Tension free surgical repairs of hernias have been developed using-synthetic mesh materials to bridge and to patch hernia defects. These repairs resulted in both a decrease in the recurrence rate as well as a decrease in the amount of a patient's post operative discomfort. Patients undergoing these more advanced procedures were able and are able to resume their normal activities sooner. Some of these earlier techniques are somewhat complicated. Several use a plug or a locating member to fit within the hernia defect itself. Also many of these earlier techniques were designed specifically for use in laparoscopic repair of hernias. Moreover, many of the prior inventions required suturing to the patient's body

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tissue. Although these medical advances are acknowledged for their usefulness and success, there remained a need or needs for more improvements in the surgical repair of hernias. Some of these earlier techniques are somewhat complicated. Several use a plug or a locating member to fit within the hernia defect itself. Also many of these earlier techniques were designed specifically for use in laparoscopic repair of hernias. Moreover, many of the prior inventions required suturing to the patient's body tissue. Although these medical advances are acknowledged for their usefulness and success, there remained a need or needs for more improvements in the surgical repair of hernias. A hernia mesh patch for use in the surgical repair of a patient's inguinal, or other abdominal wall hernias, is disclosed for permanent placement within a patient's body space. This hernia mesh patch has top and bottom layers of an inert, synthetic mesh, preferably polypropylene mesh, secured to each other with a seam. The seam surrounds and defines a pocket. The top layer has a transverse cut or slit opening into the interior pocket or pouch volume of this patch. A hernia mesh patch for use in the surgical repair of a patient's inguinal, or other abdominal wall hernias, is disclosed for permanent placement within a patient's body space. This hernia mesh patch has top and bottom layers of an inert, synthetic mesh, preferably polypropylene mesh, secured to each other with a seam. The seam surrounds and defines a pocket. The top layer has a transverse cut or slit opening into the interior pocket or pouch volume of this patch. Web site: http://www.delphion.com/details?pn=US06224616__ ·

Hernia mesh patch with stiffening layer Inventor(s): Kugel; Robert D. (Olympia, WA), Biggers; Keith D. (Southlake, TX), Inman; J. Douglas (Arlington, TX) Assignee(s): Bard ASDI Inc. (Murray Hill, NJ) Patent Number: 6,171,318 Date filed: February 11, 1999 Abstract: A hernia patch has a first layer of inert synthetic mesh material selectively sized and shaped to extend across and beyond a hernia. A second layer of inert synthetic mesh material overlies the first layer to create a generally planar configuration for the patch. The first and second layers are joined together by a seam that defines a periphery of a pouch between the layers. The pouch houses a stiffening layer to provide stiffness to the patch for urging the patch to conform to the generally planar configuration across the hernia as the surgeon withdraws his or her finger. An access slit is formed in one of the layers for insertion of a surgeon's finger or instrument into the pouch to allow the surgeon to facilitate insertion of the patch into the patient and to position the patch across the hernia. Excerpt(s): The present invention generally relates to a surgically implantable patch for use in repairing a hernia of other wound. More particularly, the present invention relates to a hernia repair patch having a stiffening layer to maintain the patch in a planar configuration. Surgically implantable mesh patches for the repair of inguinal and other abdominal wall hernias, which are intended for permanent placement within a patient's body space, have been provided and used previously. Tension free surgical repairs of hernias have been developed using synthetic mesh materials to bridge and to patch hernia defects. The repairs resulted in both a decrease in the recurrence rate as well as a decrease in the amount of a patient's post operative discomfort. Patients undergoing the more advanced procedures were able and are able to resume their normal activities sooner. Some of the earlier techniques are somewhat complicated. Several use a plug or

Patents 151

a locating member to fit within the hernia defect itself. Also, many of the earlier techniques were designed specifically for use in laparoscopic repair of hernias. Moreover, many of the prior inventions required suturing to the patient's body tissue. Although these medical advances are acknowledged for their usefulness and success, there remains a need or needs for more improvements in the surgical repair of hernias. Web site: http://www.delphion.com/details?pn=US06171318__ ·

Hernia prosthesis Inventor(s): Nicolo; Enrico (Clairton, PA) Assignee(s): C. R. Bard, Inc. (Murray Hill, NJ) Patent Number: 6,497,650 Date filed: July 28, 2000 Abstract: A prosthesis and a method for repairing a tissue or muscle wall defect, such as an inguinal hernia, near a cord-like structure, such as the spermatic cord. The prosthesis comprises a layer of repair fabric having a cord opening therethrough that is adapted to receive the cord-like structure when the prosthesis is implanted at the repair site. The prosthesis also includes a cord protector that is attachable to the repair fabric at the opening to isolate the cord-like structure from the fabric in proximity to the opening. The repair fabric may be formed from a material which is susceptible to the formation of adhesions with sensitive tissue and organs. The cord protector may be formed from material which inhibits the formation of adhesions with sensitive tissue and organs. The cord protector may overlie a portion of at least one of the first and second surfaces of the repair fabric. The cord protector may extend substantially farther away from the opening edge on one of the first and second surfaces than on the other of the first and second surfaces. The cord protector may be configured as an insert that is separate from and attachable to the repair fabric. Alternatively, the cord protector may be integral with the repair fabric to form a composite prosthesis. Excerpt(s): Various prosthetic materials have been proposed to reinforce the abdominal wall and to close abdominal wall defects. In certain procedures, the prosthetic fabric may come into contact with sensitive tissue or organs potentially leading to postoperative adhesions between the mesh and the sensitive tissue or organs. There has been a suggestion that, in an inguinal hernia repair, the prosthetic fabric may come into direct contact with the spermatic cord. Postoperative adhesions between the mesh and the spermatic cord and/or erosion of the mesh into the cord, were they to occur, could potentially affect spermatic cord structure and function. For example, tissue ingrowth could potentially result in infertility, pain or other detrimental effects due to strangulation of the spermatic cord. Uzzo et al., "The Effects of Mesh Bioprosthesis on the Spermatic Cord Structures: A Preliminary Report in a Canine Model", The Journal of Urology, Vol. 161, April 1999, pp. 1344-1349, suggests that the interposition of autologous fat between the mesh and the cord during open inguinal repair may prove beneficial. It had been proposed in U.S. Pat. No. 5,593,441, assigned to C.R. Bard, Inc., also the assignee of the present application, to repair ventral hernias and/or reconstruct chest walls using a prosthesis that is covered with an adhesion resistant barrier, such as a sheet of expanded PTFE. In the repair of ventral hernias and in chest wall reconstruction, the composite is positioned with the barrier relative to the region of potential adhesion, such as the abdominal viscera. Other configurations of composite prostheses can be found in U.S. Pat. Nos. 5,725,577 and 5,743,917, both of which are also assigned to C.R Bard, Inc. International Publication No. WO 97/35533, by the present

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Applicant and also assigned to C.R. Bard, Inc., proposed a universal composite prosthesis in which one side of a layer of mesh material is completely covered with a layer of barrier material. The mesh material promotes biological tissue ingrowth while the barrier material retards biological tissue adherence thereto. The prosthesis may be utilized for various surgical procedures, including ventral hernia repair and inguinal hernia repair. Web site: http://www.delphion.com/details?pn=US06497650__ ·

Hernia repair device Inventor(s): Rousseau; Robert A. (Ottsville, PA) Assignee(s): Ethicon, Inc. (Somerville, NJ) Patent Number: 6,616,685 Date filed: June 6, 2001 Abstract: A prosthesis for repairing a tissue or muscle wall defect includes a plurality of petals connected to one another at a common center. The petals are arranged in circular fashion and cooperate to form a substantially flat disc. The petals are also arranged in an overlapping manner such that each of the petals is movable relative to an adjacent pair of the petals. The petals are sized and shaped such that at least some of the petals come in direct contact with a surrounding structure of a tissue defect when the prosthesis is inserted therein. Excerpt(s): The present invention relates to a device for repairing a hernia defect, and more particularly, to a space-filling plug device for repairing a hernia defect. In the past, plug-type devices have been used for repairing hernia defects (e.g., openings or holes formed in a wall of an organ, through which interior organs tend to protrude). For instance, U.S. Pat. No. 6,066,776 discloses a plug-type prosthesis having multiple layers of meshes stacked one on top of another. In order to repair hernia defects, the prosthesis is pushed into an opening of a hernia defect. During the implantation process, wrinkles tend to form in or between the layers of the prosthesis. As a result, organic materials may flow through or between these wrinkles, and impede healing and/or cause recurrence of hernia. U.S. Pat. Nos. 5,356,432 and 5,716,408 disclose prostheses for hernia repair. More particularly, the prostheses have outer conical bodies for allowing same to conform to irregularities in tissue or muscle walls defining hernia defects. The outer bodies have pre-formed pleats. Due to the construction of these pleats, it is difficult to manufacture the prostheses, hence increasing production costs. Further, non-uniform forces could be applied to tissue or muscle walls around hernia defects during an implanting process. Web site: http://www.delphion.com/details?pn=US06616685__

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Hernia repair prosthesis Inventor(s): Rousseau; Robert A. (Ottsville, PA) Assignee(s): Ethicon, Inc. (Somerville, NJ) Patent Number: 6,425,924 Date filed: March 31, 2000

Patents 153

Abstract: The present invention is directed to prostheses containing a radiallyexpandable member for placement within and occlusion of a hernia opening, which member is made from a biocompatible, flexible, porous textile suitable for reinforcing tissue. Excerpt(s): The present invention relates to an implantable hernia repair prosthesis and a method for reinforcing and repairing damaged tissue or muscle walls. Various prosthetic mesh materials have been proposed to reinforce the abdominal wall and to close abdominal wall defects utilizing different repair prostheses and methods of installation. The methods of executing a surgical repair can be segregated into two main approaches. The repair can be made exclusively from the anterior side (closest to the surgeon) of the defect by dissecting the sac free of the fascia and pressing it back into the pre-peritoneal space and providing permanent closure of the defect. The closure can be provided through the application of space filling prostheses and overlay patches (tension-free techniques) or can be accomplished through the use of sutures (tension techniques). An example of a tension free anterior repair is to fold a sheet of surgical mesh fabric into a multi-layer cone configuration and then to insert the mesh plug into a hernia defect to occlude the void. Such a multi-layer prosthesis is inherently stiff and may not fully conform to variations in the contour of the defect, leaving gaps between the implant and the abdominal wall that potentially could lead to recurrent herniation. The stiff, multi-layered mesh plug also may be susceptible to kinking and buckling during placement. Web site: http://www.delphion.com/details?pn=US06425924__ ·

Hiatal hernia repair patch and method for using the same Inventor(s): Rehil; Om P. (821 N. Western Ave., Marion, IN 46952) Assignee(s): none reported Patent Number: 6,436,030 Date filed: January 3, 2001 Abstract: This invention relates to a surgical prosthesis and method of use. The hiatal hernia repair patch is a ring with an integral mesh attached to and surrounding the ring. The ring and the mesh have a slit therein extending radially so that the ring may be placed about the esophagus. The ring may be hollow or solid and is flexible so that it may be inserted through a small incision or a laparoscopic port into the abdominal cavity. The patch, including the ring and mesh, is made as a one-piece unit and is made from polypropylene or other biocompatible material. In use, the ring is placed around the esophagus, between the stomach and the diaphragm. Next, the mesh is stapled or sutured to the undersurface of the diaphragm, bridging the hiatal hernia defect. Excerpt(s): The present invention relates to a method, and a prothesis, for use in maintaining the intra-abdominal reduction of a sliding esophageal hiatal hernia. In humans, there is no anatomical valve, or discrete sphincter at the esophago-gastric (EG) junction. When anatomy in the area is normal, esophageal peristalsis pushes food through the EG junction. The stomach fills, like a sack, pulling the EG junction tighter. Normal, intact esophageal hiatal muscles prevent reflux. However, a gaping hiatal muscle sling creates a large defect around the esophagus, thereby interfering with the EG junction mechanism. This may lead to a hiatal hernia. Anatomically, hiatal hernia is a muscular defect in the diaphragm. The upper part of the stomach migrates through the defect, into the chest, or lower mediastinum. Here, negative pressure leads to free

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reflux of the stomach's acid into the esophagus. This reflux leads to an array of related symptoms and complications. Web site: http://www.delphion.com/details?pn=US06436030__ ·

Implantable esophageal sphincter apparatus for gastroesophageal reflux disease and method Inventor(s): Meah; Nizam N. (236 Plum Cir., Lake Jackson, TX 77566) Assignee(s): none reported Patent Number: 6,432,040 Date filed: September 14, 2000 Abstract: An implantable esophageal sphincter apparatus with an adjustable band to be placed at the lower part of the esophagus. The inflation of the band, or sphincter body, can be increased or decreased to adjust the tightness of the device. The inflatable sphincter body may be wrapped around the esophagus and may be connected to an inflation device with a fluid reservoir. The inflation device may have a pump mechanism that will respond to external control to increase or decrease the inflation of the sphincter body. The sphincter apparatus will be held in place at the area of implantation by sutures and by fenestration mechanisms, which will allow ingrowths of tissue or fibrous elements of the body around the sphincter apparatus or into porous materials on the sphincter apparatus. The apparatus may also include a circumferential shield on a distal side of the sphincter apparatus. The shield is adapted to fit against the distal or lower side of the patient's diaphragm and inhibits the development of a hiatus hernia, that is, a protrusion of the stomach past the diaphragm through the passage for the esophagus. Excerpt(s): The present invention relates to an implantable apparatus for use treating gastroesophageal acid reflux and particularly to an artificial sphincter for the lower esophageal sphincter. Gastroesophageal reflux disease (GERD) is one of the most common medical illnesses in today's western society. Gastroesophageal reflux occurs when the contents of the stomach, including acids and digestive fluids, leak back past the lower esophageal sphincter into the esophagus. This produces the sensation commonly referred to as "heartburn". Over prolonged periods, this condition can seriously compromise a person's health. Studies indicate that the incidence of gastroesophageal reflux is on the rise. For example, health care providers use Common Procedural Terminology ("CPT") codes to report treatment of certain conditions. In 1999, the CPT code for GERD was the most commonly used code from gastroenterologists' offices in the United States, indicating the prevalence of the condition. Incidence of this disease is similarly common in all parts of Europe and probably in any affluent society. Currently, there are four options available for treatment of gastroesophageal reflux disease. These options are life-style modification, medication, surgery, and endoscopic fundoplication. Life-style modification comprises dietary changes and positioning of body so that, with the help of gravity, upward reflux of food and acid from the stomach is prevented. This treatment is seldom effective alone. Web site: http://www.delphion.com/details?pn=US06432040__

Patents 155

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Inguinal hernia support Inventor(s): Altafi; Ali A. (5770 Rudy Dr., San Jose, CA 95124) Assignee(s): none reported Patent Number: 6,112,704 Date filed: July 14, 1999 Abstract: A support for inguinal hernia is disclosed wherein a corset garment having elasticized walls is provided with a pocket or pockets on the inside wall of the portion of the garment that is adjacent the abdomen of a wearer. A plurality of pads are provided for insertion in the pocket or pockets to provide pressure against the underlying inguinal area. The pockets are placed in a location to accommodate the location of a hernia or hernias suffered by a particular user. The number of pads placed in the pocket or pockets is selected to obtain a combined thickness of pads that affords optimum wearer comfort so that the support is thereby customized for the wearer. Excerpt(s): A hernia is the protrusion of part of an organ into or through an abnormal opening in a containing wall for the organ. The most common type of hernia is the inguinal hernia, which is due to weakness of the lower abdominal wall at its junction with the thigh in the region of the groin. Hernias frequently occur here on both sides in men and women. Commonly, hernias develop because of a congenital weakness or a prolonged or sudden strain without proper support in the region involved. Hernias occur in the middle of the abdomen particularly in women after the abdominal muscles have been weakened from childbirth. Occasionally, hernia develops at a site of weakening in a scar resulting from an invasive operation. In general, the invention disclosed herein includes a corset-like garment for use by sufferers of inguinal hernia. The garment has elasticized wall portions for surrounding the hips and buttocks of a wearer and extends into the wearer's inguinal area. A pocket or pockets is fastened in any convenient fashion to the inside of the garment in positions overlying the location of the herniated tissue. A pad or combination of pads, of sufficient thickness to provide a comfortable level of pressure to the herniated area is inserted in the pocket (or pockets for multiple hernial areas). Alternatively, an inflatable bag is located in a properly located pocket and inflated to provide the comfortable level of pressure. Although the best mode contemplated for carrying out the present invention has been shown and described herein, it will be understood that modification and variation may be made without departing from what is regarded to be the subject matter of the invention. Web site: http://www.delphion.com/details?pn=US06112704__

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Mesh plug kit for the inguinal box surgical technique for hernioplasty Inventor(s): Trabucco; Ermanno (Great Neck, NY) Assignee(s): Arcilius Consultadoria e Servicos Lda (Madeira, PT) Patent Number: 6,166,286 Date filed: September 16, 1998 Abstract: A series of kits for an indirect inguinal hernia operation for both a male patient and a female patient. The kit for the male patient comprises two plugs and one mesh piece. The plugs and mesh are made from a polymer mesh and are pretreated so that they lay flat within the body after a hernia operation. These two plugs and mesh piece are sterilized and placed within a kit so that during an operation for hernia repair, a

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doctor has the necessary plugs precut and sterilized so that he can place these plugs within a patient's body. The hernia operation involves exposing an inguinal box that is 12 centimeters in length by 4.5 centimeters in width. The first of the two plugs has a circular shape with a diameter of 5 centimeters. The second of the two plugs has a circular shape with a diameter of 4 centimeters and a center hole with a slit cut from an edge leading to the center hole. The first mesh piece has a length of 10 centimeters and a width of 4.5 centimeters and also has a center hole with a slit cut from one edge leading to the center hole. The second plug and mesh piece have holes and slits so that they can fit around a spermatic cord in a patient's body. In addition, there is also a kit for a female patient. This kit comprises the first plug and a second mesh piece that is tear drop-shape with a length of 10 centimeters, and a width of 4.5 centimeters. Since a female patient does not have a spermatic cord, the plug and mesh piece in this kit do not have holes or slits for a spermatic cord. Excerpt(s): The invention relates to a plurality of kits for use in an indirect inguinal hernia operation. The operation consists of exposing a 12 centimeter by 4.5 centimeter "Inguinal Box" for the insertion of mesh-plugs. These kits are comprised a series of plugs and mesh pieces of various shapes and sizes with one of the plugs and one of the mesh pieces having a hole in the center to fit around the spermatic cord. Many inguinal hernia plugs are known in the prior art. For example, U.S. Pat. No. 5,716,409 to Debbas discloses a reinforcement sheet for use in surgery that includes an opening to receive a spermatic cord and a passageway designed to allow the opening to fit around the spermatic cord. U.S. Pat. No. 4,769,038 to Bendavid et al. discloses a plug for the repair of a femoral hernia. The plug or prosthesis has multiple layers or panels and fits around the spermatic cord. Web site: http://www.delphion.com/details?pn=US06166286__ ·

Method for attaching hernia mesh Inventor(s): Koch; Robert L. (Cincinnati, OH), Fuchs; Richard P. (Cincinnati, OH), Thompson; Bennie (Blue Ash, OH), Kuhns; Jesse J. (Cincinnati, OH) Assignee(s): Ethicon Endo-Surgery, Inc. (Cincinnati, OH) Patent Number: 6,551,333 Date filed: December 10, 2001 Abstract: A method for delivering a plurality of individual surgical fasteners. The method includes the step of providing a surgical fastener delivery device having a drive mechanism with distal and proximal ends, the drive mechanism comprising moving and fixed opposing members, the moving member being moveable proximally and distally with respect to the delivery device, and the fixed member being fixed with respect to the delivery device, the device having the plurality of surgical fasteners located between the moving and the fixed members. The method further involves the step of penetrating tissue and placing a distal end one of the surgical fasteners within tissue, by moving the moving member distally. The method further involves the step of deploying a distal end of one of the surgical fasteners by moving the moving member proximally. Excerpt(s): The present invention relates, in general, to the repair of defects in tissue and includes a novel surgical method for placing a surgical element into tissue with a surgical instrument. More particularly, to the method of use of the surgical fastening instrument and surgical fastener in combination with a prosthetic for the repair of an

Patents 157

inguinal hernia. An inguinal hernia is a condition where a small loop of bowel or intestine protrudes through a weak place or defect within the lower abdominal muscle wall or groin of a patient. This condition commonly occurs in humans, particularly males. Hernias of this type can be a congenital defect wherein the patient is born with this problem, or can be caused by straining or lifting heavy objects. Heavy lifting may be known to create a large amount of stress upon the abdominal wall and can cause a rupture or tearing at a weak point of the abdominal muscle to create the defect or opening. In any case, the patient can be left with an unsightly bulge of intestinal tissue protruding through the defect, pain, reduced lifting abilities, and in some cases, impaction of the bowel, or possibly other complications if the flow of blood is cut off to the protruding tissue. A common solution to this problem can be surgery. In the surgical procedure, the defect is accessed and carefully examined, either through an open incision or endoscopically through an access port such as a trocar. In either case, the careful examination can be well appreciated, as a network of vessels and nerves exist in the area of a typical defect, which requires a surgeon to conduct a hernia repair with great skill and caution. Within this area can be found vascular structures such as gastric vessels, the external iliac vessels, and the inferior epigastric vessels, and reproductive vessels such as the vas deferens extending through the inguinal floor. Web site: http://www.delphion.com/details?pn=US06551333__ ·

Method for use in laparoscopic hernia repair Inventor(s): Wilk; Peter J. (185 W. End Ave., New York, NY 10023) Assignee(s): none reported Patent Number: 6,152,895 Date filed: September 27, 1993 Abstract: A method for use in laparoscopic hernia repair comprises the steps of inserting a distal end of a laparoscope through a patient's abdominal muscles to a point outside of the parietal peritoneum, and inserting through the abdominal muscles a distal end of an elongate instrument provided at that distal end with a balloon in a collapsed configuration, the balloon being transparent to optical radiation. Upon disposition of the balloon between the abdominal muscles and the peritoneum, the balloon is inflated and the instrument is subsequently manipulated from outside the patient to push the inflated balloon against connective tissues between the abdominal muscles and the peritoneum to shift the tissues to form a pre-peritoneal space. During the manipulation of the instrument with the balloon, the laparoscope is to view, through and around the inflated balloon, the connective tissues and other organic structures. Excerpt(s): This invention relates to a method for use in laparoscopic hernia repair. A hernia results when a person's abdominal wall is torn to form an opening. A portion of the person's internal body organs, including a portion of the peritoneal lining, is then displaced through the opening and into the inguinal tissues. Pain is generated upon the pinching of the displaced internal body organ or organs by the opening in the abdominal wall. Although some progress has been made in simplifying hernial repair operations, for example, through the use of laparoscopic means, there is yet opportunity for improvement. Laparoscopic repair of hernias conventionally involves the insertion of a laparoscope through a trocar sleeve or laparoscopic cannula which itself traverse abdominal muscles of the patient. The laparoscope is manipulated from outside the patient to push and displace connective tissue to thereby form a pre-peritoneal space

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which may be enlarged and maintained in an enlarged configuration by inflation with carbon dioxide gas. Web site: http://www.delphion.com/details?pn=US06152895__ ·

Multilayer prosthesis to surgically correct inguinal hernia Inventor(s): Beretta; Luciano (Arcore, IT) Assignee(s): Sofradim Production (Trevoux, FR) Patent Number: 6,565,580 Date filed: July 16, 2001 Abstract: Inguinal hernia correcting prosthesis having an upper layer and a lower layer connected to each other by a flexible band, the flexible band having a first end fixed to the upper layer next to a recess provided on an edge of the upper layer, and a second end fixed next to a hole provided in the lower layer and connected by a cut to an external edge of the lower layer, the hole being axially aligned with the band and the recess. Excerpt(s): The present invention relates to a prosthesis to surgically correct inguinal hernia and particularly to a prosthesis formed of two parallel layers of biocompatible net which are joined one to the other in a translational way. It is known that the wall defects of the inguinal canal, which cause inguinal hernia, are surgically corrected by means of prostheses formed of profiled pieces of biocompatible material, normally netshaped. Said known prostheses are generally formed of a net sheet, provided with a hole for the passage of the spermatic cord, which is applied by the surgeon on the suprafascial plane parallel to the back wall of the inguinal canal (according to the well known Liechtenstein technique). This kind of prosthesis imply the risk of relapses especially in the region of the internal inguinal orifice, due to the fact that the prosthesis is applied on a plane which is considerably distant, above said orifice. Another kind of known prosthesis consists in a so-called "plug" of biocompatible material which is inserted like a stopper in the internal inguinal orifice. Inserting said kind of prosthesis implies drawbacks due to the patient's intolerance towards the material, because of the difficult incorporation of such a voluminous and tied up prosthesis. Prostheses formed of many layers of biocompatible material have been recently proposed in the attempt to solve said drawbacks of the above described prostheses. EP-A-0719 527 describes a prosthesis for surgically correcting an inguinal hernia comprising an upper layer and a lower layer connected to each other by knitting. A hole is provided in said lower layer for the passage of the spermatic cord, and connected by means of a cut to an external edge of the same lower layer. Web site: http://www.delphion.com/details?pn=US06565580__

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Multi-point tissue tension distribution device, a brow and face lift variation, and a method of tissue approximation using the device Inventor(s): Jacobs; Daniel (Palo Alto, CA), Elson; Robert James (Palo Alto, CA) Assignee(s): Coapt Systems, Inc. (Palo Alto, CA) Patent Number: 6,485,503 Date filed: February 16, 2001

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Abstract: A tissue approximation device and processes for using the device are provided. The device is an implantable, biodegradable construct (except for hernia repairs) that has attachment points emanating from a supportive backing. The device improves the mechanical phase of wound healing and evenly distributes tension over the contact area between the device and tissue. Processes for using the device include wound closure, vascular anastomoses, soft tissue attachment and soft tissue to bone attachment. Several variations are particularly applicable to facilitating tissue approximation in surgical cosmetic applications, particularly brow lifts. Generally, scalp tissue to be lifted may be set on a brow lift device via attachment points, and the device may then be secured to a patient's cranium. Variations of the device are described along with a method of installing the brow lift device. Also described is a tool particularly useful for installing a brow lift device. Excerpt(s): This invention is in the field of surgery. More particularly, it relates to a tissue approximation device. By "approximation" we mean to include variously the specific movement of two regions of tissue towards each other, the movement of one or more selected tissue regions or areas, the maintenance and/or fixation of one or more selected tissue regions in a selected position, and the maintenance and/or fixation of a selected area of tissue against shape variation due to tissue "springiness." We will also refer to these functions as "stabilization" of a tissue region. For instance, the inventive device may be used to facilitate wound healing by holding soft tissue together under improved distribution of tension and with minimal disruption of the wound interface and its nutrient supplies. Generally, the device has multiple sites for grasping said tissue using tines or prongs or other generally sharp, projecting points, extending from and preferably affixed to a single, supportive backing. Various processes of using the inventive device are also a portion of the invention. The inventive device is preferably used for the approximation, mobilization, or fixation of tissue. As noted above, these terms are meant variously to include the specific movement of two regions of tissue towards each other, the movement of one or more selected tissue regions or areas, the maintenance of one or more selected tissue regions in a selected position, and the maintenance of a selected area of tissue against shape variation due to tissue "springiness." Using our inventive device, a variety of approximation procedures may be achieved, variously from the movement of two tissue areas towards each other at a common wound margin to the maintenance of an area of tissue in a specific position during or after a surgical procedure, e.g. brow lifts or ACL regions. For instance, our inventive device allows healing of soft tissue due to its maintenance of tissue position. The surgically induced healing of soft tissue wounds involves two phases, the mechanical phase of wound closure followed by the biochemical phase which involves protein bridging and scarring. In the mechanical phase, the edges of soft tissue are held in contact by essentially two components: 1) The physical properties and device-tissue interactions of the materials holding the tissue edges in contact, e.g. sutures or staples; and 2) An early deposition of proteinaceous material that has adhesive characteristics, e.g. fibrin glue. Web site: http://www.delphion.com/details?pn=US06485503__

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Pocketed hernia repair Inventor(s): Rousseau; Robert A. (Ottsville, PA) Assignee(s): Ethicon, Inc. (Somerville, NJ) Patent Number: 6,551,356 Date filed: March 19, 2001 Abstract: A device for surgically repairing and reinforcing a hernia includes a hernia prosthesis having a substantially planar base portion and an overlay portion, each formed from a biocompatible material. The overlay portion is peripherally attached to the base portion to define a pocket to receive a surgical instrument or a surgeon's finger for placing the prosthesis within the human body. The pocket may be formed with releasable stitching to enable it to be flattened or removed after placement and may contain a resilient member that urges the prosthesis into a flat configuration. Excerpt(s): The present invention relates to a hernia repair prosthesis, and more particularly to a substantially planar surgical mesh prosthesis for bridging a hernia. Surgically implantable mesh patches for the repair of inguinal and other abdominal wall hernias are commonly used and provide tension free repairs by bridging the hernia defect. Patches of this type constitute a structural support which decreases recurrence rates and because they do not require the displacement of tissues to cover the hernia, decrease postoperative discomfort. Frequently, prostheses of this type are sutured in place, i.e., proximate to the periphery of the patch. An alternative to suturing the prosthesis is to insert it into the properitoneal space. U.S. Pat. No. 5,916,225 to Kugel discloses a hernia prosthesis having a resilient ring made of synthetic material, such as nylon, polypropylene or polyester enclosed within a pocket formed by opposing planar segments of surgical mesh that are attached together to encapsulate the ring. A slit is provided in one of the planar segments to permit the surgeon to insert a finger therein in order to push the prosthesis through an incision in the abdominal wall into the properitoneal space and across the hernia. The resilient ring urges the pocket into a deployed planar configuration, i.e., to straighten the wrinkling and folding of the pocket that occurs in the course of its placement. The disadvantages associated with the device disclosed in U.S. Pat. No. 5,916,225 are that each layer of mesh is stiff and dense, such that the combination of two layers and the resilient ring constitutes a rigid, high mass prosthesis which tends to cause discomfort and resists conformance to the patient's anatomy. It is therefore an object of the present invention to provide a hernia repair prosthesis for use in a surgical hernia repair as generally described in U.S. Pat. No. 5,916,225 but that has lower mass, and greater flexibility. Web site: http://www.delphion.com/details?pn=US06551356__

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Prosthetic device and method for eventration repair Inventor(s): Sgro; Jean Claude (Dijon, FR) Assignee(s): Cabinet Beau de Lomenie (Paris, FR) Patent Number: 6,113,623 Date filed: December 31, 1997 Abstract: A fabric prosthetic unit for repairing an incissional hernia including a joining strip is intended to be positioned in a space created by a tear or collapse of an aponeurosis. Two substantially planer sheets of colonisable flexible prosthetic fabric

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material extend substantially parallel to each other and are linked together by the joining strip. Each of the planer sheets includes flap extensions lying opposite to each other and are on either side of an edge part of a corresponding face on the joining strip. Excerpt(s): The invention relates to the technical sector of abdominal wall reinforcements or replacements, by extension addressing cases of muscle and aponeurosis loss. More particularly, the invention concerns a prosthesis or prosthetic element for the treatment of vertical abdominal eventrations, and preferably median eventrations. A vertical eventration or vertical median eventration occurs or can occur when the aponeuroses surrounding the rectus abdominis muscles are torn, for example, by trauma or failed suturing after open abdominal surgery, or when the muscular system spontaneously collapses. The internal pushing pressure generated by the intestines on the abdominal muscle wall is so great that the space created by the tear between the rectus muscles becomes filled with intestines enveloped in the peritoneum which spills outside the body. Web site: http://www.delphion.com/details?pn=US06113623__ ·

Prosthetic device for the repair of a hernia Inventor(s): Hill; Donald G. (Hopatcong, NJ), Bustamante; Carlos (Garfield, NJ), Agarwal; Vishvaroop (Piscataway, NJ), Kammerer; Gene W. (East Brunswick, NJ) Assignee(s): Ethicon, Inc. (Somerville, NJ) Patent Number: 6,241,768 Date filed: August 19, 1998 Abstract: A prosthesis device for repairing a hernia having an insertion canal made of sheet material for extending through the hernia. The insertion canal is attached at one end to a collar and at the other end to a base that is to be on the inside of the abdominal cavity. The base may be a sheet or a pouch that is to be brought to bear on the inside the wall of the abdominal cavity. The insertion canal providing a simple way of deploying the sheet or pouch against the wall of a abdominal cavity. Excerpt(s): In conventional techniques, hernial canal repair is generally carried out by suturing. However, that method of repair is not entirely satisfactory: given that the suture line is subject to a large amount of tension, there is a risk of tearing, which could then lead to recurrence of the hernia. In order to mitigate that disadvantage, tension-free hernia repair techniques have been proposed. In particular, a known technique is to position a sheet of synthetic prosthesis material, of knit or woven mesh, over the hernial canal, to reinforce or replace the weakened tissue. For example, in open surgical repair of an inguinal hernia, a sheet or patch of mesh may be used which is positioned on the inguinal ring, on the side remote from the peritoneum, this sheet being slit to allow the spermatic cord to pass, and the two tails of the patch are then wound around the spermatic cord. The barrier thus created makes it possible for the inguinal canal floor to regenerate. Web site: http://www.delphion.com/details?pn=US06241768__

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Prosthetic repair fabric Inventor(s): Cherok; Dennis (North Smithfield, RI), Eldridge; Stephen N. (Exeter, RI), Greene; Ronald L. (Warwick, RI), Darois; Roger E. (Foster, RI) Assignee(s): C. R. Bard, Inc. (Murray Hill, NJ) Patent Number: 6,258,124 Date filed: May 10, 1999 Abstract: A prosthetic repair fabric and method for repairing an inguinal hernia in the inguinal canal. The prosthesis including a layer of mesh fabric that is susceptible to the formations of adhesions with sensitive tissue and organs, and a barrier layer that inhibits the formation of adhesions with sensitive tissue and organs. The mesh fabric including a medial section and a lateral section that are configured to be positioned adjacent the medial corner and the lateral end of the inguinal canal, respectively, when the prosthesis is placed in the inguinal canal to repair the defect. The barrier layer is positioned on the mesh fabric to inhibit the formation of adhesions between the spermatic cord and the mesh fabric. At least a portion of the lateral section of the mesh fabric is free of the barrier layer on both of its sides to promote enhanced tissue ingrowth therein. The barrier layer may include at least one flap that is to be folded through the mesh fabric to isolate the spermatic cord from internal edges of the fabric when the spermatic cord is routed through the prothesis. Excerpt(s): The present invention relates to a prosthetic repair fabric and, more particularly, to an adhesion resistant fabric for use in soft tissue repair and reconstruction. Various prosthetic mesh materials have been proposed to reinforce the abdominal wall and to close abdominal wall defects. In certain procedures, the prosthetic mesh may come into contact with sensitive tissue or organs potentially leading to postoperative adhesions between the mesh and the sensitive tissue or organs. There has been a suggestion that, in an inguinal hernia repair, the prosthetic mesh may come into direct contact with the spermatic cord. Postoperative adhesions between the mesh and the spermatic cord and/or erosion of the mesh into the cord, were they to occur, could potentially affect spermatic cord structure and function. Inguinal hernias are commonly repaired using a sheet of mesh fabric, such as BARD MESH, which may be trimmed, as necessary, to match the particular size and shape of the inguinal floor. A slit is preformed or made by the surgeon from the lateral end of the mesh opposite the medial corner of the inguinal canal toward the medial end of the mesh to form a pair of lateral tails that are separated to receive the spermatic cord therebetween. The tails may then be overlapped to encircle the cord and reinforce the internal ring. A preshaped mesh may be provided with the slit and a keyhole at the end of the slit for receiving the cord therein. Web site: http://www.delphion.com/details?pn=US06258124__

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Self-forming prosthesis for repair of soft tissue defects Inventor(s): Herweck; Steve A. (Nashua, NH), Goodwin; Jonathan L. (Nashua, NH), Gingras; Peter H. (Windham, NH) Assignee(s): Atrium Medical Corporation (Hudson, NH) Patent Number: 6,066,776 Date filed: July 16, 1997

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Abstract: A prosthesis is provided that is advantageously used to fill a soft tissue or muscle defect, such as an inquinal or femoral hernia. In a first aspect of the invention, multiple layers of a flexible, mesh material are attach together at a finite number of joins. A tab is placed at the geometric center of one of the mesh layers to facilitate insertion of the mesh into the defect. The tab also creates a blunt tip that reduces irritation and discomfort to the patient. In a second aspect of the invention, a prosthesis is provided that includes a barrier layer between two or more layers of flexible, mesh material to prevent adhesion of the device to the tissue. All layers are attached together by a finite number of joins. A tab is placed at the geometric center of one of the mesh layers to facilitate insertion of the mesh into the defect. The prostheses of the invention are selfforming in that they change from a two dimensional configuration to a three dimensional configuration upon insertion of the device into the defect. Excerpt(s): The present invention relates generally to a surgical prosthesis for repair of soft tissue defects, and more particularly to a surgical prosthesis that is composed of surgical mesh and is self-forming to readily adapt to the contour of the defect. The most common operation performed by general surgeons in the United States is inguinal herniorrhaphy. Over 600,000 such procedures are performed annually. Lichtenstein and Shore first began using a plug composed of surgical mesh to treat femoral hernias and recurrent inguinal hernias in 1968. The plug consisted of a roll of surgical mesh that was coiled into a plug and inserted into the defect to fill the defect. The plug concept of treating a hernia developed by Lichtenstein and Shore was shown to be a simpler and more reliable repair than the previous conventional technique of suturing the defect to close. The rate of recurrent herniation proved to be very low compared to the former technique. The plug, however, lacks radial support to maintain its position within the defect. Later, Gilbert and Rutkow began treating primary and recurrent hernias with an umbrella plug. A swath of surgical mesh was rolled into a cone shape and inserted into the tissue defect to occlude the void. While the plug provides more radial support than the plug of Lichtenstein and Shore, the plug, has certain disadvantages. The plug lacks the needed interior bulk to solidly fill the opening. Furthermore, the apex end of the conical mesh structure is inserted first into the defect, producing a sharp pointed edge which could cause irritation to the underlying tissue and discomfort to the patient. Since the plug is preformed and in a conical shape, it can only fill defects that are approximately its shape. Web site: http://www.delphion.com/details?pn=US06066776__ ·

Surgical prosthesis for repairing a hernia Inventor(s): Dong; Tennison S. (17220 Newhope St. (Suite 120) Assignee(s): none reported Patent Number: 6,383,201 Date filed: May 14, 1999 Abstract: A surgical prosthesis for repairing a hernia in a sturdy tension-free manner. The prosthesis includes a layer of adhesion resistant material and a first layer of tissue ingrowth receptive mesh material affixed to the layer of adhesion resistant material. A second layer of tissue ingrowth receptive mesh material is positioned adjacent the first layer of tissue ingrowth receptive mesh material and a connecting thread is interwoven between the midsections of the layers for forming a midsectional seam fastening together the three layers. The prosthesis is implanted in the hernial area of the patient in such a manner as to duplicate the structure of the original unherniated fascial tissue. The

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adhesion resistant layer faces inwardly to prevent adhesion of internal body viscera to the prosthesis. Excerpt(s): This invention relates to surgical prostheses for repairing abdominal hernias and is particularly useful for repairing ventral, large umbilical and recurrent hernias. A hernia is a rupture of the abdominal wall which provides support for internal body organs. A rupture or undesired weakening in the abdominal wall is not normally, of itself, a problem. The problem is the ensuing bulge of intestine and/or omentum which pushes its way through the opening. A conventional procedure for repairing a hernia involves making an incision over the site of the hernia, pushing the internal viscera back into the abdominal cavity and closing the opening by stitching or suturing one side firmly to the other. Unfortunately, this suturing distorts sensitive tissue, causes tension and subsequent pain, and renders the repair site susceptible to a recurrent hernia. An alternative procedure which appears to be gaining popularity involves making the incision, placing a piece of knitted mesh material over the hernial opening, holding or suturing the mesh material firmly in place and closing the incision. If properly done, there is less tissue distortion and less tension on the tissue adjacent the opening. Thus, the results are better and the patient is frequently able to resume his normal activities sooner. While this mesh approach appears to be a step in the right direction, there is, nevertheless, room for further improvement, particularly in regards to providing a tension-free repair of greater strength. Web site: http://www.delphion.com/details?pn=US06383201__ ·

System to inhibit and/or control expansion of anatomical features Inventor(s): Gabbay; Shlomo (#1 Randall Dr., Short Hills, NJ 07078) Assignee(s): none reported Patent Number: 6,572,627 Date filed: January 8, 2001 Abstract: A system according to the present invention helps to reduce consumption of food by a patient. In one aspect, the system includes a banding apparatus which may be applied to around part of a patient's stomach to reduce that part to a reduced diameter. Another aspect provides wrapping apparatus that may extend from the banding apparatus and around an upper pouch of the stomach to inhibit expansion of the upper pouch beyond a predetermined volume. The wrapping apparatus further may be anchored relative to part of the patient's body to mitigate diaphragmatic hernia. Excerpt(s): The present invention relates to weight control and, more particularly, to a system and method to inhibit gastric expansion. Obesity in adults and children has been dramatically increasing in the United States and abroad. Of particular interest is morbid obesity. Obesity typically is determined based on a body mass index (BMI), which is a ratio of weight and height. In general, a BMI of 30 or greater is considered obese and a BMI of 40 or greater is considered morbidly obese. Obesity can be associated with several detrimental physiological conditions. For example, obesity often makes it difficult to breathe (e.g., sleep apnea) and may cause severe shortness of breath. Obese women may further have irregular menstruation patterns. More serious conditions, such as gallbladder disease, hypertension, diabetes, and high blood pressure, also may accompany obesity. Physical conditions also may develop as a result of obesity, such as osteo-arthritis at various joints that are subject to increased stress due to the obese

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condition. An Obese person also may suffer from various social and psychological effects due to their condition. Web site: http://www.delphion.com/details?pn=US06572627__ ·

Systems and methods for treating tissue in the crura Inventor(s): Gaiser; John (Mountain View, CA), Utley; David (San Carlos, CA) Assignee(s): Curon Medical, Inc. (Sunnyvale, CA) Patent Number: 6,547,776 Date filed: January 3, 2000 Abstract: Tissue in the crura is treated by advancing a tissue penetrating element from a catheter tube through a wall of the esophagus. The tissue penetrating element is operated to affect a tightening of the crura, e.g., to treat hiatal hernia. Excerpt(s): In a general sense, the invention is directed to systems and methods for treating interior tissue regions of the body. More specifically, the invention is directed to systems and methods for treating dysfunction in and around the lower esophageal sphincter and cardia of the stomach, and, in particular, hernias of the stomach through the esophageal hiatus and diaphragm, commonly called hiatal hernias. The gastrointestinal tract, also called the alimentary canal, is a long tube through which food is taken into the body and digested. The alimentary canal begins at the mouth, and includes the pharynx, esophagus, stomach, small and large intestines, and rectum. In human beings, this passage is about 30 feet (9 meters) long. Small, ring-like muscles, called sphincters, surround portions of the alimentary canal. In a healthy person, these muscles contract or tighten in a coordinated fashion during eating and the ensuing digestive process, to temporarily close off one region of the alimentary canal from an other. Web site: http://www.delphion.com/details?pn=US06547776__

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Three-dimensional culture of pancreatic parenchymal cells cultured living stromal tissue prepared in vitro Inventor(s): Naughton; Brian A. (El Cajon, CA), Naughton; Gail K. (Del Mar, CA) Assignee(s): Advanced Tissue Sciences, Inc. (La Jolla, CA) Patent Number: 6,022,743 Date filed: March 8, 1999 Abstract: A stromal cell-based three-dimensional cell culture system is prepared which can be used to culture a variety of different cells and tissues in vitro for prolonged periods of time. The stromal cells and connective tissue proteins naturally secreted by the stromal cells attach to and substantially envelope a framework composed of a biocompatible non-living material formed into a three-dimensional structure having interstitial spaces bridged by the stromal cells. The living stromal tissue so formed provides the support, growth factors, and regulatory factors necessary to sustain longterm active proliferation of cells in culture and/or cultures implanted in vivo. When grown in this three-dimensional system, the proliferating cells mature and segregate properly to form components of adult tissues analogous to counterparts in vivo, which can be utilized in the body as a corrective tissue. For example, and not by way of

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limitation, the three-dimensional cultures can be used to form tubular tissue structures, like those of the gastrointestinal and genitourinary tracts, as well as blood vessels; tissues for hernia repair and/or tendons and ligaments; etc. Excerpt(s): The present invention relates to a stromal cell-based three-dimensional cell and tissue culture system and its use to form corrective structures that can be implanted and utilized in vivo. This culture system can be used for the long term proliferation of cells and tissues in vitro in an environment that more closely approximates that found in vivo. The culture system described herein provides for proliferation and appropriate cell maturation to form structures analogous to tissue counterparts in vivo. In particular, the invention relates to the use of the fibroblast-based three-dimensional cell culture system to construct complex structures such as, but not limited to, tubular sections of gastrointestinal and genitourinary tracts, blood vessels, tissues for hernia repair, tendons and ligaments. The three-dimensional cultures can be implanted in vivo to correct defects in the body. Cell culture systems have been used to study cells, expand cell populations for additional study, and in the production of recombinant gene products. However, cell culture systems have not been utilized for the repair of defects or abnormal tissues in the body. The majority of vertebrate cell cultures in vitro are grown as monolayers on an artificial substrate bathed in nutrient medium. The nature of the substrate on which the monolayers grow may be solid, such as plastic, or semisolid gels, such as collagen or agar. Disposable plastics have become the preferred substrate used in modern-day tissue or cell culture. Web site: http://www.delphion.com/details?pn=US06022743__ ·

Use of L-acetylcarnitine, L-isovalerylcarnitine, L-propionylcarnitine for increasing the levels of IGF-1 Inventor(s): De Simone; Claudio (Ardrea, IT) Assignee(s): Mendes S.R.L. (Ardea, IT), Sigma-Tau Industrie Farmaceutiche Riunite S.p.A. (Rome, IT) Patent Number: 6,380,252 Date filed: February 22, 2000 Abstract: A method is provided for increasing the levels of IGF-1 for the therapeutic treatment or prophylaxis of cytological disorders or diseases related to IGF-1 selected from the group including neuropathies of the optic nerve and of the olfactory nerve, neuralgia of the trigmeninal nerve, Bell's paralysis, amyotrophic lateral sclerosis, osteoporosis, anthropathy, arthritis, cervical spondylosis and hernia of the intervertebral discs clinical syndromes of reduced height, cachexia and acute or chronic hepatic necrosis, Turner's syndrome, sarcopoenia, growth hormone insensitivity syndromes, obesity, asthenia, myasthenia and heart asthenia, immunodeficiences and reperfusion injuries, and for the cicatrization of wounds, the healing of ulcers, the treatment of burns, tissue regeneration, cutaneous, intestinal and hepatic tissue regeneration and the formation of dentine, that includes administering, to a patient in need thereof, at least one selected from the group including L-acetylcarnitine, L-isovalerylcarnitine, and Lpropionylcarnitine or pharmacologically acceptable salts thereof. The present invention also relates to a method and composition for treating HCV and/or increasing the levels of IGF-1 of a patient in need thereof, the composition including at least one selected from the group including L-acetylcarnitine, L-isovalerylcarnitine, L-propionylcarnitine and pharmacologically acceptable salts thereof and mixtures thereof; and at least one selected from the group including L-carnitine, coenzyme Q10, vitamin E and Se-L-

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methionine and pharmaceutically acceptable salts and derivatives thereof and mixtures thereof. Excerpt(s): The present invention relates to a novel therapeutic use of L-acetylcarnitine, L-isovalerylcarnitine, L-propionylcarnitine or pharmacologically acceptable salts thereof for increasing the levels of IGF-1 (insulin-like growth factor 1) for the therapeutic treatment or prophylaxis of cytological disorders or diseases related to IGF-1. More particularly, the present invention relates to the use of L-acetylcarnitine, Lisovalerylcarnitine, L-propionylcarnitine or pharmacologically acceptable salts thereof for the therapeutic treatment or prophylaxis of individuals in whom IGF-1 contributes towards the pathogenesis of a particular disease or provokes cytological disorders. The present invention also relates to the use of any of L-acetylcarnitine, L-isovalerylcarnitine, L-propionylcarnitine or pharmacologically acceptable salts thereof in combination with any of L-carnitine, coenzyme Q10, vitamin E and/or Se-L-methionine and pharmaceutically acceptable salts and derivatives thereof in the treatment of hepatitis-C virus and/or for increasing the levels of IGF-1. Like other growth factors, IGF-1 promotes cell growth and differentiation. The administration of IGF-1 obtained as a protein purified by molecular biology methods has made it possible to confirm the effects observed in vitro with cells, on animal models and in man. Essentially, the action of IGF-1 is similar to that of insulin, that is to say an increase in the uptake of glucose, a reduction in ketones and fatty acids in the serum and an increase in protein synthesis. In accordance with these and other metabolic effects, clinical studies have been undertaken in order to evaluate the efficacy of IGF-1 in a range of diseases. IGF-1 has been administered to patients with type-II diabetes, to cachectic patients, to patients with ischemic damage at the neuronal, myocardial or renal level, and has been proposed for repairing and regenerating tissues (W. L. Lowe, Insulin-like growth factors, Scientific American Science and Medicine p. 62, March 1996). From the above, it is clear that the administration of IGF-1 may be therapeutically useful in various morbid conditions. Examples of diseases or disorders which may be prevented, cured or improved by the administration of IGF-1 include neuropathies of the optic nerve and of the olfactory nerve, neuralgia of the trigeminal nerve, Bell's paralysis, amyotrophic lateral sclerosis and other motor neuron diseases, degeneration of the retina, osteoporosis, arthropathy, arthritis, cervical spondylosis and hernia of the intervertebral discs, clinical syndromes of reduced height, cachexia, acute or chronic hepatic necrosis, Turner's syndrome, sarcopoenia, growth hormone insensitivity syndromes, diabetes, obesity, asthenia in general and in particular myasthenia and heart asthenia, immunodeficiencies and reperfusion injuries. IGF-1 moreover appears to be useful for the cicatrization of wounds, the healing of ulcers, the treatment of burns, tissue regeneration in general and in particular that of cutaneous, intestinal and hepatic tissue, and the formation of dentine. Web site: http://www.delphion.com/details?pn=US06380252__

Patent Applications on Hernia As of December 2000, U.S. patent applications are open to public viewing.10 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to hernia: 10

This has been a common practice outside the United States prior to December 2000.

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Absorbable mesh device Inventor(s): Rousseau, Robert A.; (Ottsville, PA) Correspondence: Ralph W. Selitto, Jr.; P.O. Box 1477; Edison; NJ; 08818-1477; US Patent Application Number: 20030078602 Date filed: October 19, 2001 Abstract: A hernia repair device, which is implantable in a patient's body, includes first and second layers cooperating with one another so as to form an implantable patch for repairing a hernia defect. The first layer is made from a textile material which is absorbable in a patient's body, while the second layer is made from a non-absorbable textile material. When the patch is implanted in a patient's body, the non-absorbable second layer remains permanently implanted, while the absorbable first layer is dissolved. Excerpt(s): The present invention relates to a hernia repair device and, more specifically, to a hernia patch used to repair damaged tissue or muscle walls. Mesh-type patches have been used to repair hernia defects (e.g., openings or holes formed in a wall of an organ, through which interior organs tend to protrude). Typically, these patches are permanently implanted in a patient's body and may hence cause postoperative discomfort to the patient. U.S. Pat. No. 6,224,616 B1 discloses a mesh-type patch for repairing an abdominal wall hernia. More particularly, the patch is formed by top and bottom layers made from an inert mesh material. An implantable loop is positioned between the top and bottom layers to keep the patch expanded under tension in a planar configuration. In order to repair a hernia defect, the entire patch is implanted permanently in a patient's body. Because the total mass or weight of the implanted patch is relatively large and because the patch is rigid, it tends to be noncompliant with respect to the natural anatomy of the patient and increases the risk of seroma formation and/or recurrence. Moreover, the permanent tension induced by the implantable loop may cause additional discomfort to the patient. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Apparatus and method for applying surgical staples to attach an object to body tissue Inventor(s): Mastri, Dominick L.; (Bridgeport, CT), McGarry, Richard A.; (Norwalk, CT), DeFonzo, Stephan A.; (Bridgeport, CT), Young, Wayne; (Brewster, NY), Bolanos, Henry; (East Norwalk, CT), Green, David T.; (Westport, CT) Correspondence: United States Surgical, a division of; TYCO HEALTHCARE GROUP LP; 150 Glover Avenue; Norwalk; CT; 06856; US Patent Application Number: 20020117534 Date filed: September 20, 2001 Abstract: An apparatus is disclosed for endoscopic application of surgical staples adapted to attach surgical mesh to body tissue in laparoscopic hernia surgery. The apparatus includes a frame, and a generally elongated endoscopic section connected to the frame and extending distally therefrom. A staple storage cartridge is removably supported on a pivotal support system at the distal end portion of the endoscopic section with each staple being configured and adapted to attach the mesh to the body tissue. An elongated pusher system formed of several assembled components and extending from the frame to the endoscopic section is provided for individually

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advancing at least one staple at a time distally for positioning adjacent the surgical mesh and the body tissue. The pusher system also includes a trigger system to actuate the pusher. The trigger system is provided with perceptible tactile sensing means to indicate when the legs of the staple being advanced are exposed so as to be visible to the user for positioning and orientation purposes. Anvil means provides for individually closing each staple to encompass at least a portion of the surgical mesh and to penetrate the body tissue in a manner to attach the portion of the mesh to the body tissue. Projecting distally of the cartridge support system is a pair of legs which are dimensioned and configured to engage the staple during closure to prevent unwanted roll or deformation outside of the plane of the staple. Excerpt(s): This application is a continuation-in-part of co-pending application U.S. Ser. No. 07/782,290, filed on Oct. 18, 1991. The present invention relates to an apparatus and method for applying surgical staples to attach objects to body tissue. More particularly, this invention relates to a staple applier particularly adapted for attaching surgical mesh to body tissue to reinforce a surgical repair of the body tissue, as in hernia repair. Hernias may be divided into three general classes: direct hernia, indirect hernia and femoral hernia. In a direct or indirect inguinal hernia, often a part of the intestine protrudes through a defect in the supporting abdominal wall to form a hernial sac requiring surgery which generally includes a surgical incision in the groin ranging up to six inches in length. Several layers of the abdominal wall are generally separated to reach the herniated portions. During the procedure, the hernia is closed outside the abdominal wall in a manner which resembles the tying of a sack at the neck. Often a surgical mesh is attached by sutures directly over the hernia repaired opening to provide a reinforcement to the opening. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·

Apparatus and methods for developing an anatomic space for laparoscopic hernia repair and patch for use therewith Inventor(s): Mollenauer, Kenneth H.; (Santa Clara, CA), Monfort, Michelle Y.; (Los Gatos, CA), Kieturakis, Maciej J.; (San Carlos, CA) Correspondence: United States Surgical; Diviaion of Tyco Healtcare Group LP; 150 Glover Avenue; Norwalk; CT; 06856; US Patent Application Number: 20020107539 Date filed: February 13, 2002 Abstract: Laparoscopic apparatus and method for insertion into a space or potential space in a body comprising an introducer device having a tubular member with a bore extending therethrough. A tunneling shaft assembly is provided and is slidably mounted in the bore of the introducer device. The tunneling shaft assembly includes a tunneling shaft having proximal and distal extremities. A tunneling member is mounted on the distal extremity of the tunneling shaft. A balloon assembly is provided which is removably secured to the tunneling shaft. The balloon assembly includes a balloon wrapped about said tunneling shaft. A sheath is provided which encloses the balloon on the tunneling shaft. The sheath has a slit extending longitudinally thereof permitting the sheath to be removed whereby the balloon can be released and inflated. A tubular member is provided which has a balloon inflation lumen thereon and is coupled to the balloon for inflating said balloon.

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Excerpt(s): This invention relates to an apparatus and method for developing an anatomic space for laparoscopic hernia repair and a patch for use therewith. In the past, in developing spaces and potential spaces within a body, blunt dissectors or soft-tipped dissectors have been utilized to create a dissected space which is parallel to the plane in which the dissectors are introduced into the body tissue. This often may be in an undesired plane, which can lead to bleeding which may obscure the field and make it difficult to identify the body structures. In utilizing such apparatus and methods, attempts have been made to develop anatomic spaces in the anterior, posterior or lateral to the peritoneum. The same is true for plural spaces and other anatomic spaces. Procedures that have been performed in such spaces include varocele dissection, lymph node dissection, sympathectomy and hernia repair. In the past, the inguinal hernia repair has principally been accomplished by the use of an open procedure which involves an incision in the groin to expose the defect in the inguinal floor, remove the hernial sac and subsequently suture the ligaments and fascias together to reinforce the weakness in the abdominal wall. Recently, laparoscopic hernia repairs have been attempted by inserting laparoscopic instruments into the abdominal cavity through the peritoneum and then placing a mesh to cover the hernia defect. Hernia repair using this procedure has a number of disadvantages, principally because the mesh used for hernia repair is in direct contact with the structures in the abdominal cavity, as for example the intestines, so that there is a tendency for adhesions to form in between these structures. Such adhesions are known to be responsible for certain occasionally serious complications. Such a procedure is also undesirable because typically the patch is stapled into the peritoneum, which is a very thin unstable layer covering the inner abdomen. Thus, the stapled patch can tear away from the peritoneum or shift its position. Other laparoscopic approaches involve cutting away the peritoneum and stapling it closed. This is time consuming and involves the risk of inadvertent cutting of important anatomic structures. In addition, such a procedure is undesirable because it requires the use of a general anesthesia. There is therefore a need for a new and improved apparatus and method for developing an anatomic space and particularly for accomplishing hernia repair by laparoscopy. In general, it is an object of the present invention to provide an apparatus and method for developing an anatomic space. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·

Balloon device for use in surgery and method of use Inventor(s): Jervis, James E.; (San Mateo, CA) Correspondence: United States Surgical, a division of; TYCO HEALTHCARE GROUP LP; 150 Glover Avenue; Norwalk; CT; 06856; US Patent Application Number: 20020032456 Date filed: September 4, 2001 Abstract: A balloon device useful for dissecting tissue or retracting tissue for the purpose of providing space for laproscopic surgery comprising a balloon having at least two protuberances in its distal region. The present device is particularly useful in bladder neck suspension and hernia repair procedures. Excerpt(s): This is a continuation of application Ser. No. 08/570,766, filed Dec. 12, 1995, the disclosure of which is incorporated herein by reference, which is a continuation-inpart of application Ser. No. 08/403,012, filed on Mar. 10, 1995, which is a continuationin-part of application Ser. No. 08/388,233, filed Feb. 13, 1995, which is a continuation-inpart of application Ser. No. 08/267,488, filed Jun. 29, 1994, which is a continuation-in-

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part of application Ser. No. 08/124,283, filed Sep. 20, 1993, which is a continuation-inpart of application Ser. No. 08/073,737, filed Jun. 8, 1993, which is a division of application Ser. No. 07/893,988, filed Jun. 2, 1992. My application Ser. No. 08/717,794, filed Sep. 20, 1996 discloses a device of the type disclosed and claimed herein. The disclosure of each of these prior applications is hereby incorporated by reference in its entirety. The present invention constitutes specially shaped balloon dissection or retraction devices and their use. The invention relates generally to an apparatus and method for developing an anatomic space for laproscopic procedures and, more specifically, to an apparatus and method particularly suitable for surgical procedures in which there is a need to dissect around an obstruction or around an area which it would be undesirable to dissect. The present invention provides a device which can be used to dissect around a hernia and in bladder neck suspension procedures, also known as urethropoxy, in which avoidance of the pubic symphysis is desirable. The present invention comprises a balloon suitable for tissue dissection or tissue retraction which has at least two protuberances (which may be referred to as "legs", "arms", "horns" or other descriptive term) at its distal region and its method of use. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·

Coil fastener applier and removal method Inventor(s): Holsten, Henry E.; (Wolcott, CT), Savage, Robert C.; (Stratford, CT), Markus, Richard L.; (Milford, CT) Correspondence: Paul R. Audet, Esq.; United States Surgical; Division of Tyco Healthcare Group LP; 150 Glover Avenue; Norwalk; CT; 06856; US Patent Application Number: 20030009441 Date filed: April 15, 2002 Abstract: There is provided a surgical coil fastener applier for use in applying helical coil fasteners in surgical procedures, such as hernia repair, to affix surgical mesh to tissue. The coil fastener applier includes a housing having a handle extending therefrom and a trigger pivotally mounted on the housing. An elongated tubular portion extends from the housing and includes a drive rod rotatably supported therein and slidably supporting a plurality of coil fasteners thereon. A drive assembly is provided within the housing to rotate the drive rod and coil fasteners. The drive assembly includes an antireverse mechanism to allow rotation of the drive rod in only one direction. An actuation assembly is provided within the housing to convert the motion of the trigger into rotary motion for supply to the drive assembly. The drive assembly includes structure to limit the amount of rotary motion supplied to the drive assembly. The drive assembly further includes a ratchet and pawl mechanism to prevent a partial cycling of the coil fastener applier. Also provided are various coil fasteners for use with the coil fastener applier. The surgical coil fastener applier is configured and dimensioned to remove a coil fastener from tissue or drive a fastener previously applied to tissue further into the tissue. A lockout mechanism is provided to immobilize the drive rod relative to the elongated tubular portion. Excerpt(s): This application is a continuation-in-part of U.S. application Ser. No. 08/717,492, filed Sep. 20, 1996, entitled Coil Fastener Applier, the disclosure of which is incorporated by reference herein. Various surgical procedures require instruments capable of applying fasteners to tissue to form tissue connections or to secure objects to tissue. For example, during hernia repair it is often desirable to fasten a mesh to body tissue. In certain hernias, such as direct or indirect inguinal hernias, a part of the

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intestine protrudes through a defect in the support abdominal wall to form a hernial sac. The defect may be repaired using an open surgery procedure in which a relatively large incision is made and the hernia is closed off outside the abdominal wall by suturing. The mesh is attached with sutures over the opening to provide reinforcement. Currently endoscopic techniques for hernia repair utilize fasteners, such as, surgical staples or clips, to secure the mesh to the tissue to provide reinforcement to the repair and structure for encouraging tissue ingrowth. The staples or clips need to be compressed against the tissue and mesh to secure the two together. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·

Deployment apparatus for supple surgical materials Inventor(s): Rousseau, Robert A.; (Ottsville, PA) Correspondence: Ralph W. Selitto, Jr.; P.O. Box 1477; Edison; NJ; 08818-1477; US Patent Application Number: 20020173804 Date filed: May 15, 2001 Abstract: A hernia prosthesis deployment device includes an elongated rod through which a drawstring extends forming a loop at the distal end. The size of the loop is controlled by pulling on an end of the drawstring extending from the proximal end of the rod. A plurality of independent segments are threaded onto the drawstring loop in bead-like fashion, such that when the loop is expanded, the loop with segments is flexible. When the loop is contracted, the segments force the loop into a planar configuration. A surgical patch is attached to the loop such that it can be folded and pushed into position in the body. Thereafter, the loop is contracted by pulling the drawstring forcing the loop and attached patch into a planar configuration to cover the defect to be repaired. Excerpt(s): The present invention relates to an apparatus for placing and deploying supple surgical materials such as surgical mesh within the body, and more particularly to a substantially planar surgical mesh prosthesis for bridging a hernia and an apparatus for placing and deploying the prosthesis. Modern surgical techniques are intended to be minimally invasive. Endoscopic surgery is a prime example of this minimally invasive approach and has led to the development of various instruments that may be inserted through a small incision to operate internally. In some circumstances, such as with specimen retrieval pouches or organ pouches and bags, the surgical instrument places, controls and/or deploys a supple material, e.g., a latex bag. The supple material may assume folded, expanded and contracted states, e.g., for inserting, opening and closing within the body. Accordingly, various apparatus have been devised to accomplish these transitions and functions relative to supple surgical materials like latex sheeting and textiles, but these apparatus are frequently complex, expensive and utilize exotic materials. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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EB matrix production from fetal tissues and its use for tissue repair Inventor(s): Bell, Eugene; (Boston, MA), Russakovsky, Vladimir; (Boston, MA), Dai, Jianwu; (Boston, MA) Correspondence: ELLEN LEONNIG; TEI BIOSCIENCES, INC.; 7 ELKINS STREET; BOSTON; MA; 02127; US Patent Application Number: 20020182261 Date filed: November 28, 2001 Abstract: A method of forming and preserving a bioremodelable, biopolymer scaffold material by subjecting animal tissue to chemical and mechanical processing. In addition to skin tissue, another source of EBM is a blood vessel. EBM may be used for hernia repair, colon, rectal, vaginal and or urethral prolapse treatment; pelvic floor reconstruction; muscle flap reinforcement; lung tissue support; rotator cuff repair or replacement; periosteum replacement; dura repair; pericardial membrane repair; soft tissue augmentation; intervertebral disk repair; and periodontal repair. EBM may also be used as a urethral sling, laminectomy barrier or spinal fusion device. Excerpt(s): This application is a continuation-in-part application of U.S. application Ser. No. 09/871,518, filed May 31, 2001, the entire contents of which are herein incorporated by reference. This invention relates to the field of tissue engineering, and in particular to animal-derived, bioremodelable, biopolymer scaffold materials used to repair animal tissue. The term "bioremodelable" or "bioremodelability" refers to a material that lends itself to the breakdown by cells that occupy it and use it as a template for creating a replacement made up mainly of newly synthesized components secreted by the cells. Rebuilding the human body is a significant industry. Human tissue banks and synthetic polymers do not meet the need for repair or replacement of body parts. High on the list of alternative sources of material used to meet this need are animal tissues prepared in new ways that reduce their immunogenicity and maximize their usefulness and efficacy. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Helical fastener and applicator for surgical procedures Inventor(s): Jervis, James E.; (Atherton, CA) Correspondence: Chief Patent Counsel; United States Surgical; Division of Tyco Healthcare Group LP; 150 Glover Avenue; Norwalk; CT; 06856; US Patent Application Number: 20020058967 Date filed: October 25, 2001 Abstract: A device and method for deploying helical fasteners which may be used to attach a prosthesis to tissue, e.g., to attach a mesh patch in a hernia repair procedure. A helical coil fastener which is inhibited from undesirable migration after installation is also provided. Excerpt(s): The present invention relates to surgical fasteners. In particular, the invention relates to helical fasteners and a means for containing and applying a plurality of them in the course of laparoscopic surgery. The time consuming processing of traditional suturing necessitated the development of surgical fasteners. By shortening the time of the suturing process, surgical fasteners reduce blood loss and trauma to the patient. For open surgery, there has been a substantial amount of activity in developing staples and staple applicators to be used to secure tissue elements, e.g., in wound

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closure. Staples have also found use in attaching prostheses, e.g., the mesh patches used to repair hernias. The use of staples has now become widespread, but with the advent of minimally invasive, or laparoscopic, surgery, the amount of room available for fastening devices to operate in has decreased substantially. In addition, in some instances, e.g., laparoscopic hernia repair, the surgeon has access to only one side of the tissue to which the mesh patch is to be secured. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·

Hernia prosthesis Inventor(s): Nicolo, Enrico; (Clairton, PA) Correspondence: WOLF GREENFIELD & SACKS, PC; FEDERAL RESERVE PLAZA; 600 ATLANTIC AVENUE; BOSTON; MA; 02210-2211; US Patent Application Number: 20030083543 Date filed: December 2, 2002 Abstract: A prosthesis and a method for repairing a tissue or muscle wall defect, such as an inguinal hernia, near a cord-like structure, such as the spermatic cord. The prosthesis comprises a layer of repair fabric having a cord opening therethrough that is adapted to receive the cord-like structure when the prosthesis is implanted at the repair site. The prosthesis also includes a cord protector that is attachable to the repair fabric at the opening to isolate the cord-like structure from the fabric in proximity to the opening. The repair fabric may be formed from a material which is susceptible to the formation of adhesions with sensitive tissue and organs. The cord protector may be formed from material which inhibits the formation of adhesions with sensitive tissue and organs. The cord protector may overlie a portion of at least one of the first and second surfaces of the repair fabric. The cord protector may extend substantially farther away from the opening edge on one of the first and second surfaces than on the other of the first and second surfaces. The cord protector may be configured as an insert that is separate from and attachable to the repair fabric. Alternatively, the cord protector may be integral with the repair fabric to form a composite prosthesis. Excerpt(s): Various prosthetic materials have been proposed to reinforce the abdominal wall and to close abdominal wall defects. In certain procedures, the prosthetic fabric may come into contact with sensitive tissue or organs potentially leading to postoperative adhesions between the mesh and the sensitive tissue or organs. There has been a suggestion that, in an inguinal hernia repair, the prosthetic fabric may come into direct contact with the spermatic cord. Postoperative adhesions between the mesh and the spermatic cord and/or erosion of the mesh into the cord, were they to occur, could potentially affect spermatic cord structure and function. For example, tissue ingrowth could potentially result in infertility, pain or other detrimental effects due to strangulation of the spermatic cord. Uzzo et al., "The Effects of Mesh Bioprosthesis on the Spermatic Cord Structures: A Preliminary Report in a Canine Model", The Journal of Urology, Vol. 161, April 1999, pp. 1344-1349, suggests that the interposition of autologous fat between the mesh and the cord during open inguinal repair may prove beneficial. It had been proposed in U.S. Pat. No. 5,593,441, assigned to C.R. Bard, Inc., also the assignee of the present application, to repair ventral hernias and/or reconstruct chest walls using a prosthesis that is covered with an adhesion resistant barrier, such as a sheet of expanded PTFE. In the repair of ventral hernias and in chest wall reconstruction, the composite is positioned with the barrier relative to the region of potential adhesion, such as the abdominal viscera. Other configurations of composite

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prostheses can be found in U.S. Pat. Nos. 5,725,577 and 5,743,917, both of which are also assigned to C.R Bard, Inc. International Publication No. WO 97/35533, by the present Applicant and also assigned to C.R. Bard, Inc., proposed a universal composite prosthesis in which one side of a layer of mesh material is completely covered with a layer of barrier material. The mesh material promotes biological tissue ingrowth while the barrier material retards biological tissue adherence thereto. The prosthesis may be utilized for various surgical procedures, including ventral hernia repair and inguinal hernia repair. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·

Hernia repair device Inventor(s): Rousseau, Robert A.; (Ottsville, PA) Correspondence: ALLEN N. FRIEDMAN, ESQ.; C/O MCCARTER & ENGLISH, LLP; FOUR GATEWAY CENTER; 100 MULBERRY STREET; NEWARK; NJ; 07102; US Patent Application Number: 20030181988 Date filed: March 22, 2002 Abstract: An implantable prosthetic device adapted for use in repairing a hernia defect includes at least one body made from a biocompatible textile material. The body is provided with a first section and a second section inverted into the first section such that the second section is radially surrounded by the first section. The second section is movably connected to the first section such that the body is expandable or collapsible in a radial direction so as to conform to the size and shape of a hernia defect. Excerpt(s): The present invention relates to a hernia repair device and, more particularly, to a hernia repair device adapted to be implanted in a patient. Various prosthetic mesh devices have been proposed for use in repairing hernia defects (e.g., an opening in or the thinning of the tranversalis fascia through which the abdominal viscera can extrude). Some of these mesh devices are adapted for anterior-side hernia repair (i.e., repairing a hernia defect from an anterior side of the fascia proximate to the surgeon). For instance, a hernia defect can be repaired exclusively from the anterior side of the fascia by dissecting the sac from the surrounding structures, inverting the sac into an abdominal cavity and then closing the defect with the use of an overlay patch or with the use of a space-filling prosthesis having an overlay patch. One type of prosthesis adapted for anterior-side hernia repair is made from a sheet of surgical mesh fabric folded into a multi-layered cone. In order to repair a hernia defect, the prosthesis is inserted into the defect to occlude the void. Because the prosthesis is stiff, it does not readily conform to the contour of the defect, forming gaps between the prosthesis and the interior wall of the defect and hence potentially causing recurrent herniation. The stiff, multi-layered prosthesis is also susceptible to kinking and buckling during its placement into the defect. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Hernia repair mesh prosthesis, and method of using same Inventor(s): Tyagi, Narendra S.; (Bloomfield Hills, MI) Correspondence: CARRIER BLACKMAN AND ASSOCIATES; 24101 NOVI ROAD; SUITE 100; NOVI; MI; 48375 Patent Application Number: 20020042658 Date filed: October 9, 2001 Abstract: A hernia repair prosthetic element includes: a central portion which covers a hernia opening within a patient; plural support portions integrally connected about a periphery of the central portion for securing the central portion in covering relation to the hernia opening; the prosthetic element, including the central and support portions, being a substantially planar member formed of flexible mesh material; the support portions being foldable relative to the central portion so that the prosthetic element can be selectively manipulated between folded and unfolded shapes; the support portions being adapted to securely engage various components of the patient's body surrounding the hernia opening; and openings are formed through the central portion for passage of fluid therethrough. The prosthetic element has only two basic shapes, one for use in relation to all groin hernias and one for use in relation to all abdominal hernias. The flexible mesh material may be of propylene or other suitable materials, the central portion has an enhanced strength, such as being formed of two layers of the mesh material, and the central portion may be stretchable to absorb greater forces imposed thereon. Excerpt(s): The present invention relates to novel hernia repair mesh prostheses, and to methods of using same to repair hernias. More particularly, the present invention relates to such prostheses which drastically reduce hernia recurrences and which are relatively simple to construct and install, and to methods of using same. Hernias are common medical problems involving a protrusion of an organ or body part through a rupture in connective tissue or through a wall of a cavity in which is normally enclosed. Some known types of hernias are in the groin area, including direct, indirect and femoral hernias, and others are in the abdominal wall. Medical devices and procedures for repairing hernias are widely known, and have been reported well over one hundred years ago, and treatment of hernias has gone through incremental improvements over time, including the early work of A. P. Cooper, The Anatomy And Surgical Treatment Of Abdominal Hernia In Two Parts, London, Longman, Rees, Orme, Brown and Green 1827, the landmark advancement known as the Lichtenstein repair (I L Lichenstein, A G Schulman, P K Amid, M M Montilor, The Tension Free Hernioplasty, AnJ Surgery, 1989; 157:188-193, the placement of a truss-like mechanical support in the preperitoneal space utilizing the principals of Pascal's Law, R E Stoppa, J L Rives, C R Warlaumont, et al., The Use Of Dacron In The Repair Of Hernias Of The Groin, Surg. Clin. North Am, 1984; 64:269-285, and placement of mesh posterior to the muscles and investing fascia of the abdominal wall such that the kinetic force of abdominal pressure is used in a reverse role--instead of causing a hernia, the force is used to support the repair, L M Nyhus, R E Condon, H N Harkins, Clinical Experience With Preperitoneal Hernial Repair For All Types Of Hernias Of The Groin, Am J Surg, 1960; 100:234-244. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Hernia repair prosthesis Inventor(s): Rousseau, Robert A.; (Ottsville, PA), Rousseau, Robert A.; (Ottsville, PA) Correspondence: AUDLEY A. CIAMPORCERO JR.; JOHNSON & JOHNSON; ONE JOHNSON & JOHNSON PLAZA; NEW BRUNSWICK; NJ; 08933-7003; US, AUDLEY A. CIAMPORCERO JR.; JOHNSON & JOHNSON; ONE JOHNSON & JOHNSON PLAZA; NEW BRUNSWICK; NJ; 08933-7003; US Patent Application Number: 20020147457 Date filed: May 31, 2002 Abstract: The present invention is directed to prostheses containing a radiallyexpandable member for placement within and occlusion of a hernia opening, which member is made from a biocompatible, flexible, porous textile suitable for reinforcing tissue. Excerpt(s): The present invention relates to an implantable hernia repair prosthesis and a method for reinforcing and repairing damaged tissue or muscle walls. The present invention relates to an implantable hernia repair prosthesis and a method for reinforcing and repairing damaged tissue or muscle walls. Various prosthetic mesh materials have been proposed to reinforce the abdominal wall and to close abdominal wall defects utilizing different repair prostheses and methods of installation. The methods of executing a surgical repair can be segregated into two main approaches. The repair can be made exclusively from the anterior side (closest to the surgeon) of the defect by dissecting the sac free of the fascia and pressing it back into the pre-peritoneal space and providing permanent closure of the defect. The closure can be provided through the application of space filling prostheses and overlay patches (tension-free techniques) or can be accomplished through the use of sutures (tension techniques). Various prosthetic mesh materials have been proposed to reinforce the abdominal wall and to close abdominal wall defects utilizing different repair prostheses and methods of installation. The methods of executing a surgical repair can be segregated into two main approaches. The repair can be made exclusively from the anterior side (closest to the surgeon) of the defect by dissecting the sac free of the fascia and pressing it back into the pre-peritoneal space and providing permanent closure of the defect. The closure can be provided through the application of space filling prostheses and overlay patches (tension-free techniques) or can be accomplished through the use of sutures (tension techniques). An example of a tension free anterior repair is to fold a sheet of surgical mesh fabric into a multi-layer cone configuration and then to insert the mesh plug into a hernia defect to occlude the void. Such a multi-layer prosthesis is inherently stiff and may not fully conform to variations in the contour of the defect, leaving gaps between the implant and the abdominal wall that potentially could lead to recurrent herniation. The stiff, multilayered mesh plug also may be susceptible to kinking and buckling during placement. An example of a tension free anterior repair is to fold a sheet of surgical mesh fabric into a multi-layer cone configuration and then to insert the mesh plug into a hernia defect to occlude the void. Such a multi-layer prosthesis is inherently stiff and may not fully conform to variations in the contour of the defect, leaving gaps between the implant and the abdominal wall that potentially could lead to recurrent herniation. The stiff, multilayered mesh plug also may be susceptible to kinking and buckling during placement. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Hernia repair prosthesis Inventor(s): Rousseau, Robert A.; (Ottsville, PA) Correspondence: AUDLEY A. CIAMPORCERO JR.; JOHNSON & JOHNSON; ONE JOHNSON & JOHNSON PLAZA; NEW BRUNSWICK; NJ; 08933-7003; US Patent Application Number: 20020147457 Date filed: May 31, 2002 Abstract: The present invention is directed to prostheses containing a radiallyexpandable member for placement within and occlusion of a hernia opening, which member is made from a biocompatible, flexible, porous textile suitable for reinforcing tissue. Excerpt(s): The present invention relates to an implantable hernia repair prosthesis and a method for reinforcing and repairing damaged tissue or muscle walls. The present invention relates to an implantable hernia repair prosthesis and a method for reinforcing and repairing damaged tissue or muscle walls. Various prosthetic mesh materials have been proposed to reinforce the abdominal wall and to close abdominal wall defects utilizing different repair prostheses and methods of installation. The methods of executing a surgical repair can be segregated into two main approaches. The repair can be made exclusively from the anterior side (closest to the surgeon) of the defect by dissecting the sac free of the fascia and pressing it back into the pre-peritoneal space and providing permanent closure of the defect. The closure can be provided through the application of space filling prostheses and overlay patches (tension-free techniques) or can be accomplished through the use of sutures (tension techniques). Various prosthetic mesh materials have been proposed to reinforce the abdominal wall and to close abdominal wall defects utilizing different repair prostheses and methods of installation. The methods of executing a surgical repair can be segregated into two main approaches. The repair can be made exclusively from the anterior side (closest to the surgeon) of the defect by dissecting the sac free of the fascia and pressing it back into the pre-peritoneal space and providing permanent closure of the defect. The closure can be provided through the application of space filling prostheses and overlay patches (tension-free techniques) or can be accomplished through the use of sutures (tension techniques). An example of a tension free anterior repair is to fold a sheet of surgical mesh fabric into a multi-layer cone configuration and then to insert the mesh plug into a hernia defect to occlude the void. Such a multi-layer prosthesis is inherently stiff and may not fully conform to variations in the contour of the defect, leaving gaps between the implant and the abdominal wall that potentially could lead to recurrent herniation. The stiff, multilayered mesh plug also may be susceptible to kinking and buckling during placement. An example of a tension free anterior repair is to fold a sheet of surgical mesh fabric into a multi-layer cone configuration and then to insert the mesh plug into a hernia defect to occlude the void. Such a multi-layer prosthesis is inherently stiff and may not fully conform to variations in the contour of the defect, leaving gaps between the implant and the abdominal wall that potentially could lead to recurrent herniation. The stiff, multilayered mesh plug also may be susceptible to kinking and buckling during placement. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Hiatal hernia repair patch and method for using the same Inventor(s): Rehil, Om P.; (Marion, IN) Correspondence: Richard C. Litman; LITMAN LAW OFFICES, LTD.; P.O. Box 15035; Arlington; VA; 22215; US Patent Application Number: 20010049539 Date filed: January 3, 2001 Abstract: This invention relates to a surgical prosthesis and method of use. The hiatal hernia repair patch is a ring with an integral mesh attached to and surrounding the ring. The ring and the mesh have a slit therein extending radially so that the ring may be placed about the esophagus. The ring may be hollow or solid and is flexible so that it may be inserted through a small incision or a laparoscopic port into the abdominal cavity. The patch, including the ring and mesh, is made as a one-piece unit and is made from polypropylene or other biocompatible material. In use, the ring is placed around the esophagus, between the stomach and the diaphragm. Next, the mesh is stapled or sutured to the undersurface of the diaphragm, bridging the hiatal hernia defect. Excerpt(s): This application claims the benefit of U.S. Provisional Patent Application Ser. No. 60/179,149, filed Jan. 31, 2000. The present invention relates to a method, and a prothesis, for use in maintaining the intra-abdominal reduction of a sliding esophageal hiatal hernia. In humans, there is no anatomical valve, or discrete sphincter at the esophago-gastric (EG) junction. When anatomy in the area is normal, esophageal peristalsis pushes food through the EG junction. The stomach fills, like a sack, pulling the EG junction tighter. Normal, intact esophageal hiatal muscles prevent reflux. However, a gaping hiatal muscle sling creates a large defect around the esophagus, thereby interfering with the EG junction mechanism. This may lead to a hiatal hernia. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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MESH PLUG KIT FOR THE INGUINAL BOX SURGICAL TECHNIQUE FOR HERNIOPLASTY Inventor(s): TRABUCCO, ERMANNO E.; (GREAT NECK, NY) Correspondence: COLLARD & ROE; 1077 NORTHERN BLVD; ROSLYN; NY; 11576 Patent Application Number: 20010049538 Date filed: July 16, 1999 Abstract: A series of kits for an indirect and direct inguinal hernia operations for both male patient and a female patients. The kit for the male patient comprises two plugs and one mesh piece. The plugs and mesh are made from a polymer mesh and are pretreated so that they lay flat within the body after a hernia operation. These two plugs and mesh piece are sterilized and placed within a kit so that during an operation for hernia repair, a doctor has the necessary plugs precut and sterilized so that he can place these plugs within a patient's body. In this case, the plugs and mesh pieces have holes and slits formed to receive a spermatic cord. Since a female patient does not have a spermatic cord, the plug and mesh piece in this kit do not have holes or slits for a spermatic cord. There is also a third kit for large primary and recurrent groin hernias that cause weakening of the entire floor canal. This kit contains a flat rigid hernial plug and a preshaped mesh piece. The two pieces are attached in a two-mesh pair.

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Excerpt(s): In accordance with 35 U.S.C.sctn.120, this application is a continuation in part application based upon U.S. application Ser. No. 09/154,458 filed on Sep. 16, 1998. The invention relates to a plurality of kits for use in an indirect and direct inguinal hernia operations and large primary and recurrent groin hernias. The operation consists of exposing a 12 centimeter by 4.5 centimeter "Inguinal Box" for the insertion of mesh plugs. These kits are comprised of a series of plugs and mesh pieces of various shapes and sizes with one of the plugs and one of the mesh pieces having a hole in the center to fit around the spermatic cord. Many inguinal hernia plugs are known in the prior art. For example, U.S. Pat. No. 5,716,409 to Debbas discloses a reinforcement sheet for use in surgery that includes an opening to receive a spermatic cord and a passageway designed to allow the opening to fit around the spermatic cord. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·

METHOD AND APPARATUS FOR ENDOSCOPIC DISRUPTION OF LOWER ESOPHAGEAL RING AND STRICTURES Inventor(s): RANDALL, CHARLES W.; (SAN ANTONIO, TX) Correspondence: WAYNE J COLTON INC; THE MILAM BUILDING SUITE 1032; 115 EAST TRAVIS STREET; SAN ANTONIO; TX; 78205; US Patent Application Number: 20020128675 Date filed: November 1, 1999 Abstract: An improved tool for endoscopic disruption of lower esophageal ring generally comprises scissors adapted to be inserted into a patient's esophagastric junction through a flexible endoscope. The scissors pair comprises a blunt tipped instrument having a pair of short cutting edges operable through an axially disposed cable or the like. In practice, the instrument is inserted into a flexible endoscope and thereby orally inserted into the patient's lower esophagus. Once inserted into the lower esophagus, the instrument is utilized to precisely sever a lower esophageal ring at a plurality of radial locations. Once effectively disrupted, any associated shelf effect will generally self-correct. Other procedures, such as hiatal hernia repair, may then be completed, whereafter the endoscope may be removed from the patient. The procedure should require only about 20 minutes to complete and will result in a minimum of patient discomfort as well as instant relief from the symptoms of LER. Excerpt(s): This application claims, under 35 USC.sctn.119(e), all available benefit of the filing of U.S. provisional patent application Serial No. 60/134,435 filed May 17, 1999. By this reference, the full disclosure, including the drawings, of U.S. provisional patent application Serial No. 60/134,435 is incorporated herein as though now set forth in its entirety. The present invention relates to an apparatus for use in endoscopic surgery. More particularly, the invention relates to an endoscopic apparatus specifically adapted for surgical disruption of the lower esophageal, or Schatzki's, ring. First reported in 1953 by Schatzki and Gary as a ring-like structure at the juncture of the esophageal and gastric mucosa, lower esophageal, or Schatzki's, ring ("LER") remains controversial as to exact location, etiology and clinical importance. It is generally agreed, however, that if left untreated the incomplete diaphragm in the lower esophageal lumen that characterizes this thin, submucosal, scar can result in serious complications of swallowing. In most cases, LER presents as episodic or progressive dysphagia although, in the extreme, it can progress into a total obstruction of the esophagus. In any case, it is generally accepted standard of care to treat symptomatic LER through surgical interruption or dilation of the ring.

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Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·

Method and device for treating equine hernias Inventor(s): Spencer, Marjorie Ann Brown; (Norco, CA) Correspondence: Gunther Hanke; Fulwider Patton Lee & Utecht, LLP; Suite 1550; 200 Oceangate; Long Beach; CA; 90802; US Patent Application Number: 20030041858 Date filed: August 30, 2001 Abstract: A device and method for treating equine hernia wherein a manipulator element is held in place to exert pressure on the affected abdomen to thereby push the bowel into the abdominal cavity. Any movements made by the horse, especially as by the act of walking or exercising, cause the manipulator element to shift slightly and thereby automatically manipulate the hernial ring. Such manipulation serves to expedite the healing process often obviating the need for surgical intervention. Excerpt(s): The present invention generally relates to the treatment of equine hernias and more particularly pertains to a device and method that provides for the continuous and automatic manipulation of a hernia to promote healing. Equines are fairly susceptible to hernias. Many such hernias are `umbilical hernias` that are caused at birth such as when the mare rises too soon and thereby subjects the umbilical cord that is still attached to the foal to an excessive amount of tension. Such tension may cause a tear in the abdominal wall leaving only the skin covering the abdominal area to provide support. Hernias may additionally be caused by rearing, kicking, jumping or straining and are common to post-operative abdominal surgery. Ventral rupture may arise from an external injury. A hernia appears as a bulge in the animal's abdominal region which at the very least is considered unsightly and at worst may lead to complete failure of the abdominal wall and loss of all support for the intestines. The hernia may become strangulated which is a serious condition causing swelling, pain, hemorrhage, exudation, peritonitis and if not relieved, necrosis which can be fatal. Hernias are especially problematic in four-legged animals as the orientation of their abdominal region causes the entire weight of the intestines to be borne by the abdominal wall. This is further aggravated in horses in view of the immense size and weight of their intestines. Surgery is common practice for the repair of equine hernias. In addition to the substantial cost involved, surgery always poses some degree of risk, including adverse reaction to anesthesia, infection as well as other potential complications along with an extended period of convalescence. Many heretofore employed methods for treating hernias in actuality merely amount to an effort to stabilize the herniation pending surgery by trussing or bandaging the region. While this typically prevents the hernia from increasing in size and may ease some of the discomfort that may be associated with the condition, it rarely if ever causes the hernia to heal or even shrink in size. The standard accepted method for the treatment of umbilical hernias in equine foals if the hernia is relatively small has been to wait until they are at least six months old to determine whether the hernia will heal on its own while optionally manipulating the hernia a few times a day during this period of time. Such manipulation includes applying pressure to the distended intestine so as to urge it back into the abdominal cavity while massaging the hernial ring in an effort to stimulate it to close. Some success can be realized with the massaging of the hernia. It has been theorized that such manipulation of the hernial ring actually induces the formation of new cell growth or scar tissue and the gradual tightening and closing of the ring. Additionally, the

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distended materials are forced back through the hernial ring and into the abdominal cavity to relieve some of the tension that the hernial ring is subjected to. The disadvantage associated with such approach is that the massaging sessions are time consuming and must be performed repeatedly. If by the sixth month the hernia has not healed, a clamp is attached to the skin where the hernia is located and tightened on a daily basis until the veterinarian determines the hernia to be ready for surgical repair. The clamp is painful to the foal and the entire approach is rather labor intensive insofar as daily attention is required. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·

Method and device for use in minimally invasive approximation of muscle and other tissue Inventor(s): Drews, Michael; (Sacramento, CA), Howell, Thomas; (Palo Alto, CA), Willis, David; (Palo Alto, CA), Hermann, George D.; (Portola Valley, CA), de la Pena, Jose; (Lomas Virreyes, MX), de la Torre, Roger; (Wentzville, MO), Khouri, Roger; (Key Biscayne, FL) Correspondence: Cameron A. King; Morrison & Foerster LLP; 425 Market Street; San Francisco; CA; 94105; US Patent Application Number: 20020065534 Date filed: October 2, 2001 Abstract: Tissue approximation devices for the minimally invasive approximation of muscle or fascia, such as approximation of the rectus muscles in the abdomen (abdominoplasty), or hernia repair and other such applications using minimally invasive methods to access and perform the procedures thereby reducing or eliminating visible scars. Excerpt(s): The present invention relates generally to medical apparatus and methods and more particularly to devices and methods for the minimally invasive approximation of muscle, fascia or other tissue such as approximation of the rectus muscles in the abdomen (abdominoplasty), hernia repair, closing fascial defects and other such applications where fascia or other tissue structures need approximating, that provide patient benefit using minimally invasive techniques that, among other benefits, reduce or eliminate visible scars. In the case of diastasis of the rectus muscle and ventral hernias, separation of muscles and fascia from each other can occur over time due to stretching or weakening of tissue, resulting in protrusion at the region of separation of otherwise contained material, e.g. Fat, tissue, or intestine. For example, during pregnancy or over time with weight gain, the rectus abdominals muscles, (the large muscles that run longitudinally along the abdomen from the torso to the groin of a human being), can diverge from each other, resulting in a flabby appearance or in some cases protrusion of accumulated fat or other structures through the separated region. Many people desire to undergo surgical repair of the separated muscles either to repair the herniation of material, or in less extreme cases, purely for cosmetic reasons, sometimes in conjunction with liposuction or removal of excess skin and fatty tissue. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Method for attaching hernia mesh Inventor(s): Fuchs, Richard P.; (Cincinnati, OH), Thompson, Bennie; (Blue Ash, OH), Koch, Robert L.; (Cincinnati, OH), Kuhns, Jesse J.; (Cincinnati, OH) Correspondence: AUDLEY A. CIAMPORCERO JR.; JOHNSON & JOHNSON; ONE JOHNSON & JOHNSON PLAZA; NEW BRUNSWICK; NJ; 08933-7003; US Patent Application Number: 20020087170 Date filed: December 10, 2001 Abstract: A method for delivering a plurality of individual surgical fasteners. The method includes the step of providing a surgical fastener delivery device having a drive mechanism with distal and proximal ends, the drive mechanism comprising moving and fixed opposing members, the moving member being moveable proximally and distally with respect to the delivery device, and the fixed member being fixed with respect to the delivery device, the device having the plurality of surgical fasteners located between the moving and the fixed members. The method further involves the step of penetrating tissue and placing a distal end one of the surgical fasteners within tissue, by moving the moving member distally. The method further involves the step of deploying a distal end of one of the surgical fasteners by moving the moving member proximally. Excerpt(s): This Continuation in Part application is related to the following copending patent applications: application Ser. No. 09/692,633 [Attorney Docket No. END-668]; application Ser. No. 09/692,627 [Attorney Docket No. END-671] and application Ser. No. 09/692,636 [Attorney Docket No. END-672], which are hereby incorporated herein by reference. The present invention relates, in general, to the repair of defects in tissue and includes a novel surgical method for placing a surgical element into tissue with a surgical instrument. More particularly, to the method of use of the surgical fastening instrument and surgical fastener in combination with a prosthetic for the repair of an inguinal hernia. An inguinal hernia is a condition where a small loop of bowel or intestine protrudes through a weak place or defect within the lower abdominal muscle wall or groin of a patient. This condition commonly occurs in humans, particularly males. Hernias of this type can be a congenital defect wherein the patient is born with this problem, or can be caused by straining or lifting heavy objects. Heavy lifting may be known to create a large amount of stress upon the abdominal wall and can cause a rupture or tearing at a weak point of the abdominal muscle to create the defect or opening. In any case, the patient can be left with an unsightly bulge of intestinal tissue protruding through the defect, pain, reduced lifting abilities, and in some cases, impaction of the bowel, or possibly other complications if the flow of blood is cut off to the protruding tissue. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Multi-point tension distribution device, a brow and face lift variation, and a method of tissue approximation using the device Inventor(s): Jacobs, Daniel; (Palo Alto, CA), Elson, Robert James; (Palo Alto, CA) Correspondence: Johney U. Han; Morrison & Foerster LLP; 755 Page Mill Road; Palo Alto; CA; 94304-1018; US Patent Application Number: 20010044637 Date filed: February 16, 2001

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Abstract: A tissue approximation device and processes for using the device are provided. The device is an implantable, biodegradable construct (except for hernia repairs) that has attachment points emanating from a supportive backing. The device improves the mechanical phase of wound healing and evenly distributes tension over the contact area between the device and tissue. Processes for using the device include wound closure, vascular anastomoses, soft tissue attachment and soft tissue to bone attachment. Several variations are particularly applicable to facilitating tissue approximation in surgical cosmetic applications, particularly brow lifts. Generally, scalp tissue to be lifted may be set on a brow lift device via attachment points, and the device may then be secured to a patient's cranium. Variations of the device are described along with a method of installing the brow lift device. Also described is a tool particularly useful for installing a brow lift device. Excerpt(s): This is a continuation-in-part of U.S. patent application Ser. No. 09/574,603, filed May 19, 2000 entitled "MULTI-POINT TENSION DISTRIBUTION SYSTEM DEVICE AND METHOD OF TISSUE APPROXIMATION USING THAT DEVICE TO IMPROVE WOUND HEALING", the entirety of which is incorporated herein by reference. This invention is in the field of surgery. More particularly, it relates to a tissue approximation device. By "approximation" we mean to include variously the specific movement of two regions of tissue towards each other, the movement of one or more selected tissue regions or areas, the maintenance and/or fixation of one or more selected tissue regions in a selected position, and the maintenance and/or fixation of a selected area of tissue against shape variation due to tissue "springiness." We will also refer to these functions as "stabilization" of a tissue region. For instance, the inventive device may be used to facilitate wound healing by holding soft tissue together under improved distribution of tension and with minimal disruption of the wound interface and its nutrient supplies. Generally, the device has multiple sites for grasping said tissue using tines or prongs or other generally sharp, projecting points, extending from and preferably affixed to a single, supportive backing. Various processes of using the inventive device are also a portion of the invention. The inventive device is preferably used for the approximation, mobilization, or fixation of tissue. As noted above, these terms are meant variously to include the specific movement of two regions of tissue towards each other, the movement of one or more selected tissue regions or areas, the maintenance of one or more selected tissue regions in a selected position, and the maintenance of a selected area of tissue against shape variation due to tissue "springiness." Using our inventive device, a variety of approximation procedures may be achieved, variously from the movement of two tissue areas towards each other at a common wound margin to the maintenance of an area of tissue in a specific position during or after a surgical procedure, e.g. brow lifts or ACL regions. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·

Percutaneous cannula delvery system for hernia patch Inventor(s): Pacey, John Allen; (Vancouver, CA) Correspondence: DR JOHN A. PACEY; 6290 COLLINGWOOD ST; VANCOUVER; BC; V6N 1T6; CA Patent Application Number: 20020103494 Date filed: January 30, 2002 Abstract: A method and prosthesis design and manufacture is described for repair of Inguinal and other Hernias by a combination of a percutaneous endoscopic imaging

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system with a proprietary patch. The nitinol or metal reinforced plastic fabric patch is introduced into the hernial defect by use of a cannula and after expansion and deployment is capable of stabilizing the peritoneum by use of a unique radiating skeleton with polydirectional hooks and also provide the necessary structural support. The system may be enhanced by use of a harpoon toggle suture, which is an integral component of the system and provides unprecedented strength of the repair. The patch is constructed of an adhesion resistant layer, a nitinol, plastic or metal frame and also a layer or elements designed to promote adherence. An alternate unitary construction is contemplated made of molded plastic to reproduce all of the structural features important to the function of the system. Excerpt(s): Hernia repair surgery was done for many years by means of direct suturing techniques. The techniques often failed because the local tissues lacked strength so mesh reinforcement strategies were developed. The technique has evolved over recent years to involve placement of mesh plugs , mesh implants. Cannula delivery has been described. Many procedures are now done with local or regional anesthetic techniques. ePTFE (expanded polytetrafluroethylene or Goretex.RTM.) has been used in a hernia patch placed in the peritoneum with laparoscopy and stapled with metal staples as a simple onlay but was found to be inferior to preperitoneal techniques as it was associated with a higher failure rate. Laparoscopic repair is also done widely using a preperitoneal mesh implant for strength. This solution is unique in combining a hooked reinforced intraperitoneal or preperitoneal patch made from polytetrafluroethylene, silicon, or some non adherent material. The development here uses local anesthesia, a percutaneous trocar and cannula delivery method that may be done rapidly and in radiology suites as well as in surgical operating rooms. The use of laparoscopy imaging greatly facilitates the accurate placement of a blocking plug and reduces the time required to carry out the procedure. Local anesthesia is required. The development of superelastic nitinol metal or other materials permit a strong moderate size patch to be placed through a cannula and have the predetermined shape recover completely from material memory after placement. Standard steel wire has less elastic recovery. Expanded PTFE graft materials have resulted in products that may be safely placed in the peritoneal cavity without fear of generation of excessive numbers of adhesive bands or adherence to the bowel. Thus material development has aided in creation of this unique solution to the hernia problem. The current filing defines additions to the preferred method of application of this technology. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·

Pocketed hernia repair Inventor(s): Rousseau, Robert A.; (Ottsville, PA) Correspondence: Ralph W. Selitto, Jr.; P.O. Box 1477; Edison; NJ; 08818-1477; US Patent Application Number: 20020133236 Date filed: March 19, 2001 Abstract: A device for surgically repairing and reinforcing a hernia includes a hernia prosthesis having a substantially planar base portion and an overlay portion, each formed from a biocompatible material. The overlay portion is peripherally attached to the base portion to define a pocket to receive a surgical instrument or a surgeon's finger for placing the prosthesis within the human body. The pocket may be formed with releasable stitching to enable it to be flattened or removed after placement and may contain a resilient member that urges the prosthesis into a flat configuration.

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Excerpt(s): The present invention relates to a hernia repair prosthesis, and more particularly to a substantially planar surgical mesh prosthesis for bridging a hernia. Surgically implantable mesh patches for the repair of inguinal and other abdominal wall hernias are commonly used and provide tension free repairs by bridging the hernia defect. Patches of this type constitute a structural support which decreases recurrence rates and because they do not require the displacement of tissues to cover the hernia, decrease postoperative discomfort. Frequently, prostheses of this type are sutured in place, i.e., proximate to the periphery of the patch. An alternative to suturing the prosthesis is to insert it into the properitoneal space. U.S. Pat. No. 5,916,225 to Kugel discloses a hernia prosthesis having a resilient ring made of synthetic material, such as nylon, polypropylene or polyester enclosed within a pocket formed by opposing planar segments of surgical mesh that are attached together to encapsulate the ring. A slit is provided in one of the planar segments to permit the surgeon to insert a finger therein in order to push the prosthesis through an incision in the abdominal wall into the properitoneal space and across the hernia. The resilient ring urges the pocket into a deployed planar configuration, i.e., to straighten the wrinkling and folding of the pocket that occurs in the course of its placement. The disadvantages associated with the device disclosed in U.S. Pat. No. 5,916,225 are that each layer of mesh is stiff and dense, such that the combination of two layers and the resilient ring constitutes a rigid, high mass prosthesis which tends to cause discomfort and resists conformance to the patient's anatomy. It is therefore an object of the present invention to provide a hernia repair prosthesis for use in a surgical hernia repair as generally described in U.S. Pat. No. 5,916,225 but that has lower mass, and greater flexibility. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·

Prosthetic repair fabric Inventor(s): Darois, Roger E.; (Foster, RI), Cherok, Dennis; (North Smithfield, RI), Eldridge, Stephen N.; (Exeter, RI), Greene, Ronald L.; (Warwick, RI) Correspondence: Jason M. Honeyman; Wolf, Greenfield & Sacks, P.C.; Federal Reserve Plaza; 6000 Atlantic Avenue; Boston; MA; 02210; US Patent Application Number: 20020052654 Date filed: July 6, 2001 Abstract: A prosthetic repair fabric and method for repairing an inguinal hernia in the inguinal canal. The prosthesis including a layer of mesh fabric that is susceptible to the formations of adhesions with sensitive tissue and organs, and a barrier layer that inhibits the formation of adhesions with sensitive tissue and organs. The mesh fabric including a medial section and a lateral section that are configured to be positioned adjacent the medial corner and the lateral end of the inguinal canal, respectively, when the prosthesis is placed in the inguinal canal to repair the defect. The barrier layer is positioned on the mesh fabric to inhibit the formation of adhesions between the spermatic cord and the mesh fabric. At least a portion of the lateral section of the mesh fabric is free of the barrier layer on both of its sides to promote enhanced tissue ingrowth therein. The barrier layer may include at least one flap that is to be folded through the mesh fabric to isolate the spermatic cord from internal edges of the fabric when the spermatic cord is routed through the prothesis. Excerpt(s): The present invention relates to a prosthetic repair fabric and, more particularly, to an adhesion resistant fabric for use in soft tissue repair and reconstruction. Various prosthetic mesh materials have been proposed to reinforce the

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abdominal wall and to close abdominal wall defects. In certain procedures, the prosthetic mesh may come into contact with sensitive tissue or organs potentially leading to postoperative adhesions between the mesh and the sensitive tissue or organs. There has been a suggestion that, in an inguinal hernia repair, the prosthetic mesh may come into direct contact with the spermatic cord. Postoperative adhesions between the mesh and the spermatic cord and/or erosion of the mesh into the cord, were they to occur, could potentially affect spermatic cord structure and function. Inguinal hernias are commonly repaired using a sheet of mesh fabric, such as BARD MESH, which may be trimmed, as necessary, to match the particular size and shape of the inguinal floor. A slit is preformed or made by the surgeon from the lateral end of the mesh opposite the medial corner of the inguinal canal toward the medial end of the mesh to form a pair of lateral tails that are separated to receive the spermatic cord therebetween. The tails may then be overlapped to encircle the cord and reinforce the internal ring. A preshaped mesh may be provided with the slit and a keyhole at the end of the slit for receiving the cord therein. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·

System to inhibit and/or control expansion of anatomical features Inventor(s): Gabbay, Shlomo; (Short Hills, NJ) Correspondence: Gary J. Pitzer; AMIN & TUROCY, L.L.P.; 24TH Floor, National City Center; 1900 East 9TH Street; Cleveland; OH; 44114; US Patent Application Number: 20020091395 Date filed: January 8, 2001 Abstract: A system according to the present invention helps to reduce consumption of food by a patient. In one aspect, the system includes a banding apparatus which may be applied to around part of a patient's stomach to reduce that part to a reduced diameter. Another aspect provides wrapping apparatus that may extend from the banding apparatus and around an upper pouch of the stomach to inhibit expansion of the upper pouch beyond a predetermined volume. The wrapping apparatus further may be anchored relative to part of the patient's body to mitigate diaphragmatic hernia. Excerpt(s): The present invention relates to weight control and, more particularly, to a system and method to inhibit gastric expansion. Obesity in adults and children has been dramatically increasing in the United States and abroad. Of particular interest is morbid obesity. Obesity typically is determined based on a body mass index (BMI), which is a ratio of weight and height. In general, a BMI of 30 or greater is considered obese and a BMI of 40 or greater is considered morbidly obese. Obesity can be associated with several detrimental physiological conditions. For example, obesity often makes it difficult to breathe (e.g., sleep apnea) and may cause severe shortness of breath. Obese women may further have irregular menstruation patterns. More serious conditions, such as gallbladder disease, hypertension, diabetes, and high blood pressure, also may accompany obesity. Physical conditions also may develop as a result of obesity, such as osteo-arthritis at various joints that are subject to increased stress due to the obese condition. An Obese person also may suffer from various social and psychological effects due to their condition. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Keeping Current In order to stay informed about patents and patent applications dealing with hernia, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “hernia” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on hernia. You can also use this procedure to view pending patent applications concerning hernia. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

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CHAPTER 7. BOOKS ON HERNIA Overview This chapter provides bibliographic book references relating to hernia. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on hernia include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “hernia” (or synonyms) into the “For these words:” box. You should check back periodically with this database which is updated every three months. The following is a typical result when searching for books on hernia: ·

Inguinal Hernia: Advances or Controversies? Source: New York, NY: Radcliffe Medical Press. 1994. 524 p. Contact: Available from Radcliffe Medical Press. Scoville, Patterson Inc., 141 Fifth Avenue, Suite 8N, New York, NY 10010. PRICE: $99.50 (as of 1995). ISBN: 1857750462. Summary: This comprehensive medical text explains the various types of hernia repairs (classical, contemporary, and laparoscopic) and analyzes in detail the newer laparoscopic approaches. Complications, recurrences, technical, and cost considerations are covered in the text, which includes divergent professional viewpoints. Eighty-six chapters, authored by specialists in the field, cover history, embryology and anatomy; the biology of hernia formation; diagnosis, classification, and anesthesia; biomaterials in hernia repairs; the economics of hernia repair; complications and controversies in open hernia repair; techniques of laparoscopic hernia repairs; and complications, recurrences, and technical considerations in laparoscopic hernia repair. The last 36 chapters present

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selected studies on hernia repair. Each chapter includes numerous black and white photographs, figures, and references. A subject index concludes the volume. ·

Nyhus and Condon's Hernia, Fifth Edition Source: Philadelphia, PA: Lippincott Williams and Wilkins. 2002. 650 p. Contact: Available from Lippincott Williams and Wilkins. P.O. Box 1600, Hagerstown, MD 21741. (800) 638-3030 or (301) 223-2300. Fax (301) 223-2365. PRICE: $179.00 plus shipping and handling. ISBN: 0781719623. Summary: This lengthy textbook offers a comprehensive look at the surgical management of hernias. The authors stress that there are four general changes in the area of hernia surgery that have affected the way surgeons practice their craft: the widespread acceptance of the 'tension-free' principle, the routine use of prosthetic materials, the realization that the preperitoneal space can be used for hernia repair, and therapeutic laparoscopy. The text offers 50 chapters in eight sections: etiology, history and anatomy of hernias; conventional groin hernia repairs; laparoscopic and endoscopic groin hernia repairs; complications of groin hernia; ventral incisional hernias; pediatric hernias; diaphragmatic hernias; and miscellaneous considerations in hernia repair. Each chapter includes extensive references and black and white photographs, drawings, and charts. A subject index concludes the volume.

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Hernia. 4th ed Source: Philadelphia, PA: Lippincott-Raven Publishers. 1995. 615 p. Contact: Available from Lippincott-Raven Publishers. 1185 Avenue of the Americas, New York, NY 10036. (212) 930-9500. Fax (212) 869-3495. PRICE: $149 (as of 1995). ISBN: 0397512864. Summary: This medical textbook presents a comprehensive look at the diagnosis and treatment of hernia. Forty-five chapters are presented in 9 sections: an overview of groin hernia; clinical aspects of groin hernia; special problems; hernias of the abdominal wall; perineal hernias; intra-abdominal hernias; general aids to repair; diaphragmatic hernia; and medicolegal aspects of hernia. Each chapter, written by experts in the field, includes black-and-white photographs, tables, figures, and extensive references. A detailed subject index concludes the volume.

Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in PrintÒ). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “hernia” at online booksellers’ Web sites, you may discover nonmedical books that use the generic term “hernia” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “hernia” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): ·

A Colour Atlas of Inguinal Hernias and Hydroceles in Infants and Children (Single Surgical Procedures) by Caroline M. Doig, Clive Preece (Illustrator); ISBN: 0723410038; http://www.amazon.com/exec/obidos/ASIN/0723410038/icongroupinterna

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A Colour Atlas of Transthoracic Repair of Hiatus Hernia (Single Surgical Procedures, Vol 43) by Robert Pringle; ISBN: 081516842X; http://www.amazon.com/exec/obidos/ASIN/081516842X/icongroupinterna

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Abdominal hernias by Hugh Dennis; ISBN: 0838578799; http://www.amazon.com/exec/obidos/ASIN/0838578799/icongroupinterna

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Abdominal Wall Hernias: An Atlas of Anatomy and Repair by John L. Madden, John P. L. Madden (1998); ISBN: 0721612881; http://www.amazon.com/exec/obidos/ASIN/0721612881/icongroupinterna

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Abdominal Wall Hernias: Principles and Management by Robert Bendavid (Editor); ISBN: 0387950044; http://www.amazon.com/exec/obidos/ASIN/0387950044/icongroupinterna

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All About Hiatus Hernia and Its Treatment Without Drugs by David Potterton; ISBN: 057202164X; http://www.amazon.com/exec/obidos/ASIN/057202164X/icongroupinterna

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Atlas of Hernia Surgery by Caspar Henselmann (Illustrator), George E. Wantz (1991); ISBN: 0881677248; http://www.amazon.com/exec/obidos/ASIN/0881677248/icongroupinterna

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Atlas of Hernia Surgery by Volker Schumpelick; ISBN: 1556641524; http://www.amazon.com/exec/obidos/ASIN/1556641524/icongroupinterna

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Color Atlas of Inguinal Hernias and Hydroceles in Infants and Children: Single Surgical Procedures Series by Caroline May Doig; ISBN: 0874895022; http://www.amazon.com/exec/obidos/ASIN/0874895022/icongroupinterna

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Congenital Diaphragmatic Hernia (Modern Problems in Pediatrics, Vol 24) by P. Puri (Editor) (1988); ISBN: 3805548079; http://www.amazon.com/exec/obidos/ASIN/3805548079/icongroupinterna

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Coping Successfully with Your Hiatus Hernia by Tom Smith (1997); ISBN: 0859697819; http://www.amazon.com/exec/obidos/ASIN/0859697819/icongroupinterna

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Coping With a Hernia (Overcoming Common Problems Series) by David Delvin; ISBN: 0859697835; http://www.amazon.com/exec/obidos/ASIN/0859697835/icongroupinterna

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CT and MRI of disk herniations; ISBN: 0387191631; http://www.amazon.com/exec/obidos/ASIN/0387191631/icongroupinterna

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CT and MRI of disk herniations; ISBN: 3540191631; http://www.amazon.com/exec/obidos/ASIN/3540191631/icongroupinterna

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Early discharge from hospital for patients with hernia or varicose veins : report of a randomised controlled trial; ISBN: 0113202431; http://www.amazon.com/exec/obidos/ASIN/0113202431/icongroupinterna

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Esophageal hiatus hernia : rationale and results of anatomic repair by Thomas Gahagan; ISBN: 0398034893; http://www.amazon.com/exec/obidos/ASIN/0398034893/icongroupinterna

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Hernia by Lloyd M. Nyhus, Robert E. Condon (Editor); ISBN: 0397512864; http://www.amazon.com/exec/obidos/ASIN/0397512864/icongroupinterna

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Hernia healers: An illustrated history by Stoppa (Author); ISBN: 2718408715; http://www.amazon.com/exec/obidos/ASIN/2718408715/icongroupinterna

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Hernia Infections: Pathophysiology, Diagnosis, Treatment, Prevention by Maximo Deysine (Editor) (2003); ISBN: 0824746120; http://www.amazon.com/exec/obidos/ASIN/0824746120/icongroupinterna

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Hernia repair without disability; a surgical atlas illustrating the anatomy, technique, and physiologic rationale of the "one-day" hernia by Irving L. Lichtenstein; ISBN: 0801630002; http://www.amazon.com/exec/obidos/ASIN/0801630002/icongroupinterna

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Hernia Repair: Open Vs Laparoscopic Approaches by Guy J. Maddern (Editor), et al (1997); ISBN: 0443055238; http://www.amazon.com/exec/obidos/ASIN/0443055238/icongroupinterna

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Hernia Repair: The Laparoscopic Approach by David C. Dunn, Donald Menzies; ISBN: 0865429081; http://www.amazon.com/exec/obidos/ASIN/0865429081/icongroupinterna

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Hernia: Surgical Anatomy and Technique by John Elias Skandalakis (Editor); ISBN: 0070577897; http://www.amazon.com/exec/obidos/ASIN/0070577897/icongroupinterna

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Hernias (Your Operation) by David Leaper, Jane Smith; ISBN: 0340620471; http://www.amazon.com/exec/obidos/ASIN/0340620471/icongroupinterna

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Hernias and Surgery of the Abdominal Wall. With contributions by numerous experts by Jean-Paul Chevrel (Author) (1998); ISBN: 3540627499; http://www.amazon.com/exec/obidos/ASIN/3540627499/icongroupinterna

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Hernias En La Pared Abdominal by M. D. Abascal, Roesch (2001); ISBN: 9684269285; http://www.amazon.com/exec/obidos/ASIN/9684269285/icongroupinterna

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Hernias of the Abdominal Wall by Joseph L. Ponka; ISBN: 0721672744; http://www.amazon.com/exec/obidos/ASIN/0721672744/icongroupinterna

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Hernias of the Diaphragm and Abdominal Wall: Discussions in Surgical Management by Siroos S Shirazi; ISBN: 0874889561; http://www.amazon.com/exec/obidos/ASIN/0874889561/icongroupinterna

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Hernia-Simple and Complex: Index of New Information and Medical Research Bible by Salvatore L.K, Dr. Leeds (1994); ISBN: 0788301365; http://www.amazon.com/exec/obidos/ASIN/0788301365/icongroupinterna

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Hiatal Hernia & Chronic Fatigue Syndrome by Patricia Ann Hellinger (2003); ISBN: 0974251003; http://www.amazon.com/exec/obidos/ASIN/0974251003/icongroupinterna

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Hiatal Hernia Syndrome; ISBN: 0938257064; http://www.amazon.com/exec/obidos/ASIN/0938257064/icongroupinterna

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Hiatal Hernia Syndrome: Insidious Link to Major Illness Guide to Healing by Theodore A. Baroody, Janice R. Swanger (Illustrator) (1987); ISBN: 0961959525; http://www.amazon.com/exec/obidos/ASIN/0961959525/icongroupinterna

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Hiatal Hernia: The Natural Approach to Overcoming Hiatal and Other GastroIntestinal Disorders by Jack Ritchason; ISBN: 1885670346; http://www.amazon.com/exec/obidos/ASIN/1885670346/icongroupinterna

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Hiatus Hernia by David Potterson, David Potterton; ISBN: 0572018592; http://www.amazon.com/exec/obidos/ASIN/0572018592/icongroupinterna

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Hiatus Hernia (The New Self Help Series) by Joan Lay; ISBN: 0722512228; http://www.amazon.com/exec/obidos/ASIN/0722512228/icongroupinterna

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Incisional Hernia by V. Schumpelick (Editor), A. N. Kingsnorth (Editor); ISBN: 3540656197; http://www.amazon.com/exec/obidos/ASIN/3540656197/icongroupinterna

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Inguinal Hernia Repair: Expert Meeting on Hernia Surgery, St. Moritz, February 2-5, 1994 by Expert Meeting on Hernia Surgery, et al (1995); ISBN: 3805560311; http://www.amazon.com/exec/obidos/ASIN/3805560311/icongroupinterna

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Inquinal Hernia: Advances or Controversies by Maurice E. Arregui, Robert Nagan (1994); ISBN: 1857750462; http://www.amazon.com/exec/obidos/ASIN/1857750462/icongroupinterna

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Internal Intra-Abdominal Hernias (Medical Intelligence Unit) by Roberto L. Estrada, Catherine E. Jeffery (Illustrator) (1994); ISBN: 1879702916; http://www.amazon.com/exec/obidos/ASIN/1879702916/icongroupinterna

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LA Hernia De Viriato: Recetario Para Hipocondriacos by Carmen Posadas, et al (2002); ISBN: 8484602397; http://www.amazon.com/exec/obidos/ASIN/8484602397/icongroupinterna

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Laparoscopic Hernia Repair by Michael S. Kavic; ISBN: 9057025388; http://www.amazon.com/exec/obidos/ASIN/9057025388/icongroupinterna

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Laparoscopic Hernia Repair: A New Standard?: International Meeting, May 6-7, 1994, Bern, Switzerland (Progress in Surgery, Vol 21) by E. Frei, et al (1995); ISBN: 3805560478; http://www.amazon.com/exec/obidos/ASIN/3805560478/icongroupinterna

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Laparoscopic Hernia Surgery: An Operative Guide by Karl A., Md. Leblanc (Editor) (2003); ISBN: 034080940X; http://www.amazon.com/exec/obidos/ASIN/034080940X/icongroupinterna

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Laparoscopic Inguinal Hernia Repair by Ara Darzi (Editor), et al (1995); ISBN: 1899066012; http://www.amazon.com/exec/obidos/ASIN/1899066012/icongroupinterna

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Laparoscopic Inguinal Hernia Repair (Laproscopic Surgical Technique) by James Rosser, James C., Jr. Rosser (1998); ISBN: 0387142444; http://www.amazon.com/exec/obidos/ASIN/0387142444/icongroupinterna

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Laparoscopic Inguinal Hernia Repair: Transabdominal & Balloon-Assisted Extraperitoneal Approaches Patient Education Program (CD-ROM for Windows & Macintosh) by James "butch" Rosser, James C., Jr. Rosser; ISBN: 0387142428; http://www.amazon.com/exec/obidos/ASIN/0387142428/icongroupinterna

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Laparoscopic Ventral Hernia Repair by S. Morales, Salvador Morales-Conde (2002); ISBN: 2287597557; http://www.amazon.com/exec/obidos/ASIN/2287597557/icongroupinterna

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Low Back and Leg Pain for Herniated Cervical Disk: New Method of Diagnosis and Conservative Treatment by Herman Kabat (1980); ISBN: 0875272460; http://www.amazon.com/exec/obidos/ASIN/0875272460/icongroupinterna

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Lumbar Disc Herniation by Robert, M.D., Ph.D. Gunzburg (Editor), et al; ISBN: 0781736005; http://www.amazon.com/exec/obidos/ASIN/0781736005/icongroupinterna

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Lumbar Disc Herniation by Franco Postacchini; ISBN: 3211831185; http://www.amazon.com/exec/obidos/ASIN/3211831185/icongroupinterna

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Management of Abdominal Hernias by Andrew Kingsnorth, Karl A. Leblanc (2003); ISBN: 034080890X; http://www.amazon.com/exec/obidos/ASIN/034080890X/icongroupinterna

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Management of Abdominal Hernias by H. Brendan Devlin, Andrew Kingsnorth; ISBN: 0412738201; http://www.amazon.com/exec/obidos/ASIN/0412738201/icongroupinterna

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Modern Hernia Repair: The Embryological and Anatomical Basis of Surgery by Lee John Skandalakis (Editor), et al; ISBN: 1850705852; http://www.amazon.com/exec/obidos/ASIN/1850705852/icongroupinterna

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New Procedures in Open Hernia Surgery by F. Corcione (2003); ISBN: 2287597662; http://www.amazon.com/exec/obidos/ASIN/2287597662/icongroupinterna

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Nyhus and Condon's Hernia by Robert J. Fitzgibbons Jr. (Editor), et al; ISBN: 0781719623; http://www.amazon.com/exec/obidos/ASIN/0781719623/icongroupinterna

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Positive Options for Hiatus Hernia: Self-Help and Treatment by Tom Smith; ISBN: 0897933184; http://www.amazon.com/exec/obidos/ASIN/0897933184/icongroupinterna

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Problems of recurrent hernia by Robert C. Kimberly; ISBN: 0398033749; http://www.amazon.com/exec/obidos/ASIN/0398033749/icongroupinterna

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Prostheses and Abdominal Wall Hernias by Robert Bendavid (Editor); ISBN: 1879702703; http://www.amazon.com/exec/obidos/ASIN/1879702703/icongroupinterna

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Repair of Hernias by Mark M. Ravitch; ISBN: 0815171048; http://www.amazon.com/exec/obidos/ASIN/0815171048/icongroupinterna

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Shackelford's Surgery of the Alimentary Tract: Mesenteric Circulation, Hernia, Small Intestine by Richard T. Shackelford, et al (1991); ISBN: 0721625096; http://www.amazon.com/exec/obidos/ASIN/0721625096/icongroupinterna

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Surgery of the Alimentary Tract: Mesentery Vasculature, Hernias, Small Intestine, Peritoneum, Omentum, Mesentery and Retroperitoneum Surgical Nutrit by Richard T. Shackelford, George D. Zuidema (1986); ISBN: 0721680887; http://www.amazon.com/exec/obidos/ASIN/0721680887/icongroupinterna

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Surgical Management of Abdominal Wall Hernias by Martin Kurzer, George E. Wantz (1998); ISBN: 1853174777; http://www.amazon.com/exec/obidos/ASIN/1853174777/icongroupinterna

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The Hernia Book: Sound Advice on Symptoms and Treatment by William P., M.D. Homan, et al; ISBN: 0890435391; http://www.amazon.com/exec/obidos/ASIN/0890435391/icongroupinterna

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The Hernia Solution: Myths, Facts, Answers by James A. Bulen, et al; ISBN: 0963011448; http://www.amazon.com/exec/obidos/ASIN/0963011448/icongroupinterna

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The Lichtenstein Hernia Repairs, and How to Do Them. Right! by Alex G. Shulman, Chuck Wiedeman (Illustrator) (1996); ISBN: 0965352609; http://www.amazon.com/exec/obidos/ASIN/0965352609/icongroupinterna

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The Official Patient's Sourcebook on Hiatal Hernia: A Revised and Updated Directory for the Internet Age by Icon Health Publications (2002); ISBN: 0597833923; http://www.amazon.com/exec/obidos/ASIN/0597833923/icongroupinterna

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The Official Patient's Sourcebook on Inguinal Hernia: A Revised and Updated Directory for the Internet Age by Icon Health Publications (2002); ISBN: 059783394X; http://www.amazon.com/exec/obidos/ASIN/059783394X/icongroupinterna

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The Original Bassini Operation for Inguinal Hernia by Alcide Chinaglia; ISBN: 8829902292; http://www.amazon.com/exec/obidos/ASIN/8829902292/icongroupinterna

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Towards an Endoscopic Intra-Uterine Treatment for Congenital Diaphragmatic Hernia: Preclinical Experimental Studies in the Foetal Lamb (Acta Biomedica Lovaniensia, 253) by Veerle Evrard (2002); ISBN: 9058672069; http://www.amazon.com/exec/obidos/ASIN/9058672069/icongroupinterna

The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “hernia” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:11 ·

A physiological approach for treatment of rectal hernias; preparation of the intestinal tract, preoperative medication and anesthetics, preparation of the patient, anatomy of the anus, rectum and sigmoid, variations in rectal herniation, technique of the operation, discussion. Author: Springer, Henry Anthony,; Year: 1944; Cincinnati, Ohio, 1962

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A physiological approach in the treatment of inguinal hernias. Author: Springer, Henry Anthony,; Year: 1965; [Cincinnati?] 1964

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Anatomy and surgery of hernia [by] Leo M. Zimmerman [and] Barry J. Anson. Author: Zimmerman, Leo M.,; Year: 1964; Baltimore, Williams; Wilkins, 1967

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Atlas of hernia repair. Author: Calman, Carl H.,; Year: 1949; St. Louis, Mosby, 1966

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Cases of the hydrocele, with observations on a peculiar method of treating that disease: to which is subjoined, a singular case of hernia vesicae urinariae, complicated with the hydrocele: and two cases of hernia incarcerata Author: Keate, Thomas,; Year: 1963; London: Printed for J. Walter., 1788

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Esophageal hiatus hernia [by] E. R. Woodward, John E. Rayl [and] John M. Clarke. Author: Woodward, Edward R. (Edward Roy),; Year: 1959; Chicago, Year Book Medical Publishers, 1970; ISBN: 0815199031

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In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is currently adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a "Books" button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.

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http://www.amazon.com/exec/obidos/ASIN/0815199031/icongroupinterna ·

Gastroesophageal reflux and hiatal hernia, by nine authors. Edited by David B. Skinner [et al.]. Author: Skinner, David B.,; Year: 1561; Boston, Little, Brown [c1972]; ISBN: 031679677

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Hernia repair without disability; a surgical atlas illustrating the anatomy, technique, and physiologic rationale of the "one day" hernia. Author: Lichtenstein, Irving L.,; Year: 1888; St. Louis, Mosby, 1970; ISBN: 801630002

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Hernia. Author: Koontz, Amos Ralph,; Year: 1966; New York, Appleton-Century-Crofts [c1963]

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Hernia. Editors: Lloyd M. Nyhus [and] Henry N. Harkins. Author: Nyhus, Lloyd M. (Lloyd Milton),; Year: 1963; Philadelphia, Lippincott [c1964]

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Hernia: one day repair. Author: Gaster, Joseph,; Year: 1839; Darien, Conn., Hafner, 1970

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Hernia; a manual for truss fitters. Author: Mitchell-Heggs, Francis Sansome.; Year: 1965; London, Churchill, 1953

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Hernia; the pathologic anatomy of the more common hernias and their anatomic repair. Author: McVay, Chester B. (Chester Bidwell),; Year: 1966; Springfield, Ill., Thomas [1954]

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Inguinal and femoral hernia; personal experience with 502 operations. Author: Ljungdahl, Ingolf.; Year: 1883; Stockholm, 1973

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Lectures on ambulant proctology and the injection treatment of hernia. Author: Woodall, Percy Hogan,; Year: 1966; Birmingham, Ala., c1932

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Oesophageal hiatus hernia. Author: Barendregt, Adam,; Year: 1962; [Arnhem, 1960]

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On the surgical anatomy of the groin, as connected with hernia of the abdomen. Author: Vaché, Alexander F.,; Year: 1967; New York, 1825

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Peritoneal recessus and foramen formations and associated intra-abdominal herniae and strangulations, by Hannes Sauramo and Juha Tapiovaara. Author: Sauramo, Hannes.; Year: 1959; Helsinki, 1949

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Physiological aims in the treatment of internal hernias and abdominal lesions with complications. Author: Springer, Henry Anthony,; Year: 1948; [Cincinnati?] c1967

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Repair of hernias. Author: Ravitch, Mark M.,; Year: 2003; Chicago, Year Book Medical Publishers [c1969]

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Symposium on surgery of hernia. Leo M. Zimmerman, guest editor. Author: Zimmerman, Leo M.,; Year: 1967; Philadelphia, Saunders, 1971

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The association of diaphragmatic hiatal hernia and gastroesophageal malignancy. Author: Michel, Javier Ochoa,; Year: 1966; [Minneapolis] 1965

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The cardia and hiatus hernia. Author: Johnson, H. Daintree (Harold Daintree); Year: 1968; London, Heinemann [1968]

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The relation of incisional and inguinal herniae, as well as of mechanical intestinal disturbances, to previous operations for appendicitis with peritonitis. Author: Pitkänen, Aune Elina,; Year: 1965; Helsinki, 1948

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Variations in surgical techniques, based on a physiological approach in the repair of hernias in the abdominal wall; scar tissue inversion technique with fascia sutures, umbilical hernias, treatment of incisional hernia following colostomy, perineal hernias, abdominal wound dehiscence or evisceration, clinical application to be observed in wound healing. Author: Springer, Henry Anthony,; Year: 1964; [Cincinnati] 1964

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Chapters on Hernia In order to find chapters that specifically relate to hernia, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and hernia using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “hernia” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on hernia: ·

Abdominal Hernias and Their Complications, Including Gastric Volvulus Source: in Feldman, M.; Friedman, L.S.; Sleisenger, M.H. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 7th ed. [2-volume set]. St. Louis, MO: Saunders. 2002. p. 369-385. Contact: Available from Elsevier. 11830 Westline Industrial Drive, St. Louis, MO 63146. (800) 545-2522. Fax (800) 568-5136. Website: www.us.elsevierhealth.com. PRICE: $229.00 plus shipping and handling. ISBN: 0721689736. Summary: A hernia is a protrusion of an organ or structure into an opening or pouch. Abdominal wall hernias protrude through the retaining walls of the abdomen and have two parts: the orifice or defect in the wall of the abdomen, and the hernia sac, which consists of peritoneum and abdominal contents. A hernia is strangulated when the vascular (blood) supply of the protruding organ is compromised and the organ becomes ischemic (without blood flow) or necrotic (with dead tissue) as a consequence. This chapter on abdominal hernias and their complications is from a comprehensive and authoritative textbook that covers disorders of the gastrointestinal tract, biliary tree, pancreas, and liver, as well as the related topics of nutrition and peritoneal disorders. Topics include diaphragmatic hernias; gastric volvulus (obstruction caused by twisting of the stomach); inguinal and femoral hernias (groin hernias); other ventral hernias, including incisional hernias, epigastric and umbilical hernias, and Spigelian hernias; pelvic and perineal hernias; lumbar hernias; and internal hernias. The chapter includes a mini-outline with page citations, full-color illustrations, and extensive references. 12 figures. 142 references.

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Unique Features of Groin Hernia Repair in Infants and Children Source: in Fitzgibbons, R.J.; Greenberg, A.G., eds. Nyhus and Condon's Hernia. Philadelphia, PA: Lippincott Williams and Wilkins. 2002. p.435-451. Contact: Available from Lippincott Williams and Wilkins. P.O. Box 1600, Hagerstown, MD 21741. (800) 638-3030 or (301) 223-2300. Fax (301) 223-2365. PRICE: $179.00 plus shipping and handling. ISBN: 0781719623. Summary: Although the surgical techniques in the repair of inguinal hernia in adults and children share common features, there are unique aspects to the childhood hernia that merit specific consideration. These relate to the pathophysiologic processes leading to the manifestation of a hernia, the differential diagnosis to be considered, and the potential for incarceration and strangulation. This chapter on unique features of groin hernia repair in infants and children is from a lengthy textbook on the surgical management of hernias. The authors present the current concepts of the embryology of childhood hernia, tools for clinical diagnosis, and techniques for operative management,

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as well as a discussion of the age-specific anesthetic risks and options for postoperative pain control. 9 figures. 48 references. ·

Cryptorchidism and Pediatric Hydrocele/Hernia Source: in Graham, S.D., Jr., et al., eds. Glenn's Urologic Surgery. 5th ed. Philadelphia, PA: Lippincott Williams and Wilkins. 1998. p. 833-842. Contact: Available from Lippincott Williams and Wilkins. P.O. Box 1600, Hagerstown, MD 21741. (800) 638-3030 or (301) 714-2300. Fax (301) 824-7390. Website: lww.com. PRICE: $199.00 plus shipping and handling. ISBN: 0397587376. Summary: Childhood hernia repair and cryptorchidism (undescended testicle) surgery represent by far the most common surgical conditions encountered in a pediatric urology practice. This chapter on cryptorchidism and pediatric hydrocele (accumulation of fluid in the testes) and hernia is from an exhaustive textbook on urologic surgery. The authors note that early treatment seems to offer a superior approach to the traditional treatment advocated at older ages. The authors review the diagnosis of these problems, detailing the physical examination to classify cryptorchidism. The usual presentation of a childhood inguinal hernia is an intermittently palpable asymptomatic groin swelling. Hydrocele presents as a scrotal mass in which the testis is not palpable and transilluminates. Current treatment indications include possible improvement and preservation of fertility; possible prevention of malignancy; prevention of testis torsion, which occurs with an increased frequency in cryptorchidism; and improvement in body image with two testes in a normal appearing scrotum. The authors briefly review hormonal therapy for cryptorchidism and then detail the surgical techniques used for these congenital anomalies, including herniorrhaphy, hydrocelectomy, orchiopexy, diagnosing absent testes, and the anticipated outcomes of the surgery. Retraction is the most common complication of orchiopexy, occurring in up to 10 percent of patients. Complications are rare following the hernia repair and hydrocelectomy. Analysis of the surgical results following orchiopexy regarding testis size, consistency, location, and vas deferens injury, indicated an overall success rate that exceeds 90 percent. 6 figures. 10 references.

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Sliding Hiatal Hernia Source: in Fitzgibbons, R.J.; Greenberg, A.G., eds. Nyhus and Condon's Hernia. Philadelphia, PA: Lippincott Williams and Wilkins. 2002. p.479-492. Contact: Available from Lippincott Williams and Wilkins. P.O. Box 1600, Hagerstown, MD 21741. (800) 638-3030 or (301) 223-2300. Fax (301) 223-2365. PRICE: $179.00 plus shipping and handling. ISBN: 0781719623. Summary: Hiatal hernia, a common finding at radiography, was first diagnosed at autopsy and was considered a congenital defect. Occasionally trauma was the causative factor, but hiatal hernia formation and its high incidence of occurrence was not appreciated until the technology of radiographic imaging was refined. This chapter on sliding hiatal hernia is from a lengthy textbook on the surgical management of hernias. The authors note that the association of sliding hiatal hernia with gastroesophageal reflux disease (GERD) was first noted in the late 1940s and the cause-and-effect relationship of the two remains controversial. The authors focus on the pathogenesis of GERD as it relates to hiatal hernia. Laparoscopic surgery has irreversibly altered the therapeutic approach to GERD. The authors review the laparoscopic surgical treatment of hiatal hernia and the causes of recurrence of the hernia. Topics include anatomy and physiology, pathophysiology, clinical presentation, radiology, endoscopy, pH

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monitoring, treatment strategies, surgical indications, laparoscopic technique, hiatal hernia recurrence, short esophagus, mesh repair, and technical considerations. The authors conclude that the diagnosis of hiatal hernia is usually straightforward, but the optimal method of repair is yet to be determined as hernia recurrence rates are high. 9 figures. 3 tables. 31 references. ·

History of the Treatment of Hernia Source: in Nyhus, L.M., and Condon, R.E., eds. Hernia. 4th ed. Philadelphia, PA: J.B. Lippincott Company. 1995. p. 3-15. Contact: Available from J.B. Lippincott Company. 12107 Insurance Way, Hagerstown, MD 21740-5184. (800) 777-2295 or (301) 714-2300. Fax (301) 824-7390. PRICE: $149 (as of 1995). ISBN: 0397512864. Summary: In this chapter from a medical textbook on hernia, the author reviews the history of the treatment of hernia. He highlights milestones in the development of surgical therapy through quotations from original texts by the surgeons. The periods covered are ancient times; Graeco-Roman medicine; the Middle Ages; the Renaissance; the post-Renaissance era; the 19th and 20th centuries; and contemporary times, including the development of laparoscopic herniorrhaphy. Appended to the chapter is a lengthy editorial comment. 7 figures. 67 references.

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Congenital Internal Abdominal Hernias: Incidence and Management Source: in Fitzgibbons, R.J.; Greenberg, A.G., eds. Nyhus and Condon's Hernia. Philadelphia, PA: Lippincott Williams and Wilkins. 2002. p.453-465. Contact: Available from Lippincott Williams and Wilkins. P.O. Box 1600, Hagerstown, MD 21741. (800) 638-3030 or (301) 223-2300. Fax (301) 223-2365. PRICE: $179.00 plus shipping and handling. ISBN: 0781719623. Summary: Internal hernia is defined as a fossa, fovea, or defect of unusual size within a body cavity, into which intestines may intrude and become incarcerated (trapped) or strangulated. This chapter on the incidence and management of congenital internal abdominal hernias is from a lengthy textbook on the surgical management of hernias. The origins of the internal hernias are multiple and include congenital defects, inflammation, infectious processes affecting the peritoneal cavity, trauma, and postoperative defects. This chapter focuses on hernias that are of congenital origin. Topics include paraduodenal hernia, Winslow's foramen, paracecal hernia, intersigmoid hernia, and congenital anomalous openings, including transmesenteric, broad ligament, and transomental. For each type or category, the authors discuss normal embryology, embryology of the defect, incidence, clinical presentation, diagnosis, and treatment strategies. 15 figures. 1 table. 76 references.

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Inguineal Hernia Source: in Schier, F. Laparoscopy in Children. Heidelberg, Germany: Springer-Verlag. 2003. p.74-81. Contact: Available from Springer-Verlag. Tiergartenstr. 17, D-69121 Heidelberg, Germany. (49)6221-487-0. Website: www.springer.de. E-mail: [email protected]. PRICE: $69.95 plus shipping and handling. ISBN: 3540429751. Summary: Most surgeons are familiar with the techniques of laparoscopic surgery, however, in children there are variations in size and technical approach. This section on

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inguinal hernia repair is from a book that describes the differences and characteristic aspects of laparoscopy in small children. The book is an atlas of numerous drawings, accompanied by textual descriptions. Technical guidelines are given on how to perform the laparoscopic procedure safely, even in small children. Illustrations depict the trocar placement, instruments used, the technique of locating and identifying different types of inguinal hernia, and surgical techniques used for the hernia repair. The aim of the book is to provide surgeons with the knowledge to extend their expertise in adult laparoscopy to children. 10 figures. ·

Reduction of Inguinal Hernia Source: in Walsh-Sukys, M.C. and Krug, S.E. Procedures in Infants and Children. Philadelphia, PA: W.B. Saunders Company. 1997. p. 378-379. Contact: Available from W.B. Saunders Company. Order Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887. (800) 545-2522. Fax (800) 874-6418 or (407) 352-3445. PRICE: $69.00. ISBN: 0721637892. Summary: This brief chapter, from a textbook of medical procedures in infants and children, describes the technique for reduction of inguinal hernia. The chapter outlines the indications, contraindications, equipment used, step-by-step procedure, and possible complications. The indications are reduction of herniated or incarcerated bowel to prevent strangulation ischemia. Contraindications include suspected ischemia or gangrene of the incarcerated bowel or hydrocele. Potential complications can include injury to the bowel from excessive compression or perforation of the bowel due to excessive compression or incarceration-associated ischemia. 1 figure. 2 references.

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Umbilical Hernia Source: in Hernia. 4th ed. Philadelphia, PA: Lippincott-Raven Publishers. 1995. p. 361371. Contact: Available from Lippincott-Raven Publishers. 1185 Avenue of the Americas, New York, NY 10036. (212) 930-9500. Fax (212) 869-3495. PRICE: $149 (as of 1995). ISBN: 0397512864. Summary: This chapter from a medical textbook on the diagnosis and treatment of hernia covers umbilical hernia. Topics include historical factors; embryology and anatomy of the umbilicus; and different types of umbilical hernias, including infantile umbilical hernia, acquired umbilical hernia, paraumbilical hernia, and umbilical hernia in adults. For each type of umbilical hernia, the author discusses diagnosis, natural history, treatment, and operative technique. 7 figures. 60 references.

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Acid in the Gullet: Heartburn, Esophagitis, and Hiatal Hernia Source: in Janowitz, H.D. Indigestion: Living Better with Upper Intestinal Problems from Heartburn to Ulcers and Gallstones. New York, NY: Oxford University Press. 1992. p. 41-57. Contact: Available from Oxford University Press. Order Department, 2001 Evans Road, Cary, NC 27513. (800) 451-7556. Fax (919) 677-1303. PRICE: $11.95 plus shipping and handling. ISBN: 019508554X. Summary: This chapter on acid related problems (heartburn, esophagitis, and hiatal hernia) is from a book that offers advice on how to take care of and avoid the whole complex of disturbances categorized as indigestion. The author reviews each of these

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three problems, covering their causes, symptoms, and the physiology of what is happening. Heartburn arises in the esophagus and results from the presence of the stomach's acid contents in the lower end of the esophagus. The acid has a direct irritating result because tissues there are not normally exposed to or prepared for the acid (compared to the stomach, which has a protective mucosal lining). The most important anatomical device protecting against heartburn is the lower esophageal sphincter (LES, which guards the opening between the esophagus and the stomach). The author explores the problem that can arise with a hiatal hernia, which can impair the LES's ability to prevent reflux of the stomach's contents into the esophagus. The LES pressure is also affected after a meal of fatty foods, by smoking, and by the presence of acid in the stomach (including the role of stomach emptying). The author also discusses diagnostic testing for acid reflux; treatment options, including habits and dietary modifications, and drug therapy; and general measures for relieving heartburn, including the role of exercise. Following is a discussion of the condition of active inflammation of the esophagus (esophagitis), including its diagnosis, medical treatment, surgery, and the problem of Barrett's esophagus. The chapter concludes with a discussion of the treatment options for hiatal hernia, focusing on the decision about surgical treatment for the condition. ·

Groin Hernia in Infants and Children Source: in Hernia. 4th ed. Philadelphia, PA: Lippincott-Raven Publishers. 1995. p. 93110. Contact: Available from Lippincott-Raven Publishers. 1185 Avenue of the Americas, New York, NY 10036. (212) 930-9500. Fax (212) 869-3495. PRICE: $149 (as of 1995). ISBN: 0397512864. Summary: This chapter on groin hernia in infants and children is from a medical textbook on the diagnosis and treatment of hernia. Topics include the historical background; the embryology of hernia and hydrocele; the clinical presentation; the physical examination and management; incarcerated hernia, including the management of premature infants, and the role of herniography; treatment modalities; and operative management, including incision, dissection, repair, circumcision, orchiopexy, operation for incarcerated hernia, operation for sliding hernia, contralateral inguinal exploration, and complications. The chapter concludes with a comment by C. Everett Koop. 11 figures. 2 tables. 79 references.

·

Incisional Hernia Source: in Hernia. 4th ed. Philadelphia, PA: Lippincott-Raven Publishers. 1995. p. 319336. Contact: Available from Lippincott-Raven Publishers. 1185 Avenue of the Americas, New York, NY 10036. (212) 930-9500. Fax (212) 869-3495. PRICE: $149 (as of 1995). ISBN: 0397512864. Summary: This chapter on incisional hernia is from a medical textbook on the diagnosis and treatment of hernia. Topics include epigastric hernia and diastasis recti, ventral hernia, the etiologic factors, clinical manifestations, timing of operation, loss of domicile, preparation for operation, antibiotic prophylaxis, absorbable prostheses, permanent prostheses, incision and initial dissection, avoidance of counterincisions, direction of closure, choosing the technique for repair, primary repair, onlay (one-layer) reinforced repair, and tissue replacement (two-layer) prosthetic repair. The chapter concludes with

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12 pages of comments on specific aspects covered within the text, each with its own references. 9 figures. 29 references. ·

Paraesophageal Hiatal Hernia Source: in Fitzgibbons, R.J.; Greenberg, A.G., eds. Nyhus and Condon's Hernia. Philadelphia, PA: Lippincott Williams and Wilkins. 2002. p.493-502. Contact: Available from Lippincott Williams and Wilkins. P.O. Box 1600, Hagerstown, MD 21741. (800) 638-3030 or (301) 223-2300. Fax (301) 223-2365. PRICE: $179.00 plus shipping and handling. ISBN: 0781719623. Summary: This chapter on paraesophageal hiatal hernia is from a lengthy textbook on the surgical management of hernias. The authors briefly discuss the four subtypes of abdominal visceral herniation, then consider incidence, pathogenesis, clinical presentation, diagnostic studies, indications for surgery, surgical management, laparoscopic technique, and complications. Symptomatic patients are candidates for paraesophageal hernia repair after careful evaluation. Although laparotomy and thoracotomy are successful approaches, laparoscopy is favored by experienced laparoscopic surgeons due to the short length of hospitalization and low complication rate and mortality. On average, patients return to normal activities within 2 to 3 weeks. The authors conclude by recommending the laparoscopic technique combined with an antireflux procedure. 10 figures. 1 table. 42 references.

·

Anatomy of the Inguinal Region and Its Relation to Groin Hernia Source: in Hernia. 4th ed. Philadelphia, PA: Lippincott-Raven Publishers. 1995. p. 16-72. Contact: Available from Lippincott-Raven Publishers. 1185 Avenue of the Americas, New York, NY 10036. (212) 930-9500. Fax (212) 869-3495. PRICE: $149 (as of 1995). ISBN: 0397512864. Summary: This chapter on the anatomy of the inguinal region and its relations to groin hernia is from a medical textbook on the diagnosis and treatment of hernia. Topics include the individual anatomic structures in the groin, including the abdominal wall, the pelvic skeleton, skin and subcutaneous tissues, innominate fascia, intercrural fibers, external oblique aponeurosis, inguinal ligament, interparietal fasciae, internal oblique muscle and aponeurosis, transversus abdominis muscle and aponeurosis, falx inguinalis and conjoined tendon, the iliopubic tract, transversalis fascia, the Cooper ligament, the iliopectineal arch, the rectus abdominis muscle and sheath, the preperitoneal space, the peritoneum, the femoral sheath, the femoral canal, and the inguinal canal and spermatic cord; the pathogenesis of groin hernias and principles of their repair; and a method for demonstrating the surgical anatomy of the groin in the autopsy room. The chapter concludes with 20 pages of comments on specific aspects covered within the text, each with its own references. 30 figures. 62 references.

·

Congenital Diaphragmatic Hernia Source: in Complete Directory for Pediatric Disorders. Millerton, NY: Grey House Publishing, Inc. 2002. p. 206-207. Contact: Available from Grey House Publishing, Inc. 185 Millerton Road, Millerton, NY 12546. Website: www.greyhouse.com. PRICE: $165.00 plus shipping and handling. ISBN: 1930956614.

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Summary: This entry from a directory of pediatric disorders covers congenital diaphragmatic hernia (CDH), a birth defect characterized by projection or bulging of organs of the abdomen into the chest cavity. This occurs as a result of an abnormal opening in the diaphragm, the dome-shaped muscle that separates the abdomen from the chest and plays an essential role in breathing. The entry describes the condition, including symptoms and findings, outlines diagnostic approaches used, and discusses treatment considerations. In newborns with CDH, immediate measures may be necessary to prevent or treat potentially life-threatening complications. Surgery to repair the diaphragmatic defect is deferred until the newborn's respiratory status has been stabilized. The entry then related references, including national associations and support groups, web sites, and some publications. ·

Why Do Human Beings Develop Groin Hernias? Source: in Fitzgibbons, R.J.; Greenberg, A.G., eds. Nyhus and Condon's Hernia. Philadelphia, PA: Lippincott Williams and Wilkins. 2002. p.3-8. Contact: Available from Lippincott Williams and Wilkins. P.O. Box 1600, Hagerstown, MD 21741. (800) 638-3030 or (301) 223-2300. Fax (301) 223-2365. PRICE: $179.00 plus shipping and handling. ISBN: 0781719623. Summary: This introductory chapter is from a lengthy textbook on the surgical management of hernias. In this chapter, the author considers why humans develop groin hernias. Topics include the anatomy of inguinal herniation, the congenital influence on the processus vaginalis, the fascia, metabolic factors, cigarette smoking and proteolysis, metastatic emphysema, aneurysm, genetic influences, spontaneous or iatrogenic trauma, physical exertion, and femoral herniation. Appended to the chapter is an editor's comment. The role of a genetically defined biochemical abnormality of fascia in patients with groin hernia is explored and supported by recent research. 23 references.

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CHAPTER 8. MULTIMEDIA ON HERNIA Overview In this chapter, we show you how to keep current on multimedia sources of information on hernia. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine.

Video Recordings An excellent source of multimedia information on hernia is the Combined Health Information Database. You will need to limit your search to “Videorecording” and “hernia” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” Type “hernia” (or synonyms) into the “For these words:” box. The following is a typical result when searching for video recordings on hernia: ·

What You Really Need to Know About Esophagitis and Hiatus Hernia Source: [Toronto, Ontario, Canada]: Videos for Patients. 1994. (videocassette). Contact: Available from Medical Audio Visual Communications, Inc. Suite 240, 2315 Whirlpool Street, Niagara Falls, NY 14305. Or P.O. Box 84548, 2336 Bloor Street West, Toronto, Ontario M6S 1TO, Canada. (800) 757-4868 or (905) 602-1160. Fax (905) 602-8720. PRICE: $99.00 (Canadian); contact producer for current price in American dollars. Order Number VFP021. Summary: This patient education videotape provides information about esophagitis and hiatus hernia. The videotape begins with a brief sketch featuring comedian John Cleese and narrator Dr. Robert Buckman illustrating the difficulties sometimes experienced by patients during the traditional doctor's explanation. Topics include a definition of esophagitis, how esophagitis is caused, the contribution of hiatus hernia to esophagitis, the symptoms of esophagitis, diagnostic considerations, drug therapy for esophagitis, and dietary and lifestyle modifications that can reduce problems with esophagitis. Dr.

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Buckman presents the medical facts, using models, simple diagrams, and graphics to supplement his explanation, and avoiding medical jargon as much as possible. ·

Inguinal Anatomy for Laparoscopic Hernia Repair Source: St. Louis, MO: Quality Medical Publishing, Inc. 1994. Contact: Available from Quality Medical Publishing, Inc. 11970 Borman Drive, Suite 222, St. Louis, MO 63146. (800) 348-7808 or, in Missouri, (314) 878-7808. Fax (314) 878-9937. PRICE: $59 for 1/2 in NTSC; $84 for PAL, SECAM, and 3/4 in formats. Summary: This videotape program is from a series of instructional videotapes designed to take viewers into the operating room for a firsthand look at laparoscopic procedures. This program focuses on documenting the anatomy of the inguinal region for laparoscopic hernia repair. A cadaver demonstration and live laparoscopic footage are used to define this anatomical region for safer hernia repairs. (AA-M).

Bibliography: Multimedia on Hernia The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in hernia (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on hernia: ·

Diaphragmatic hernia through dome of left diaphragm resulting from subphrenic abscess [motion picture] Source: [production company unknown]; S.W. Harrington; Year: 1935; Format: Motion picture; [S.l.: s.n., 1935]

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Direct and indirect inguinal hernia [videorecording]: (Shouldice repair Source: Videosurgery; Year: 1977; Format: Videorecording; Don Mills, Ont.: Southam Business Publications, c1977

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Esophageal hiatus diaphragmatic hernia with herniation of cardiac end of stomach above diaphragm, some elevation of lower end of esophagus and associated traumatic ulcer [motion picture] Source: [production company unknown]; S.W. Harrington; Year: 1938; Format: Motion picture; [United States?: s.n., 1938]

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Gastroplasty & hiatus hernia repair [videorecording] Source: Videosurgery; Year: 1978; Format: Videorecording; Don Mills, Ont.: Southam Business Publications, [1978]

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Groin hernia [videorecording]: anatomy and repair Source: Professional Research, inc; Year: 1976; Format: Videorecording; Los Angeles: Professional Research; [Glendale, Calif.: for sale by Telephone Marketing Services], c1976

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Groin hernias [sound recording]: techniques and results Source: American College of Surgeons; Year: 1979; Format: Sound recording; [Chicago]: The College, [1979]

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Herniation of entire stomach and omentum into posterior mediastinum, extending into both thoracic cavities, mostly into the right with marked elevation and distortion of the esophagus [motion picture] Source: [producer, Mayo Clinic]; S.W. Harrington; Year: 1938; Format: Motion picture; United States: [The Clinic, 1938]

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·

Hiatus hernia: fact or fancy [videorecording] Source: Faculty of Health Sciences, McMaster University. [et al.]; Year: 1976; Format: Videorecording; Hamilton, Ont.: The University, 1976

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Indirect hernia [videorecording] Source: Videosurgery; Year: 1978; Videorecording; Don Mills, Ont.: Southam Business Publications, c1978

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Inguinal hernia [videorecording]: (Mitchell-Banks repair Source: Videosurgery; Year: 1977; Format: Videorecording; Don Mills, Ont.: Southam Business Publications, c1977

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Large traumatic diaphragmatic hernia [motion picture]: with herniation of entire stomach, entire left lobe of liver, all of transverse colon, portion of small bowel, and spleen into left thoracic cavity through a rent in the left diaphragm not rupturing hiatus Year: 1938; Format: Motion picture; [S.l.: s.n., 1938]

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Large traumatic right diaphragmatic hernia [motion picture]: surgical repair through both abdominal and thoracic approach Source: [production company unknown]; S.W. Harrington; Year: 1935; Format: Motion picture; [S.l.: s.n., 1935]

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Left congenital diaphragmatic hernia through a persistant pleuro peritoneal hiatus [motion picture] Source: [production company unknown]; S.W. Harrington; Year: 1935; Format: Motion picture; [S.l.: s.n., 1935]

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Left diaphragmatic hernia due to congenital absence of posterior 1 Source: 4 of diaphragm / [production company unknown]; S.W. Harrington; Year: 1935; Format: Motion picture; [S.l.: s.n., 1935]

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Male genitalia, rectum, and hernias [videorecording] Source: produced for the J.B. Lippincott Company by Jacoby/Storm Productions, Inc; Year: 1982; Format: Videorecording; Philadelphia: Lippincott, c1982

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Management of abdominal hernias. Source: Kingsnorth, A. N; Year: 2003; London: Arnold; New York, NY: Distributed in the USA by Oxford University Press, 2003

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Paraesophageal diaphragmatic hernia through enlarged esophageal hiatus [motion picture] Source: [production company unknown]; S.W. Harrington; Year: 1935; Format: Motion picture; [S.l.: s.n., 1935]

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Preperitoneal hernioplasty for massive sliding hernia [motion picture] Source: [presented by] University of Washington School of Medicine; produced in the Department of Health Sciences Illustration; Year: 1961; Format: Motion picture; [United States]: The University, [1961]

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Reconstruction of the cardia and hiatal hernia repair [motion picture]: Belsey Mark IV technique Source: David B. Skinner; produced by the Dept. of Photography, Johns Hopkins Univ. School of Medicine; Year: 1969; Format: Motion picture; [Baltimore]: Skinner; [Danbury, Conn.: for loan by Davis and Geck], 1969

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Repair of sliding indirect inguinal hernia [motion picture] Source: College of Medical Evangelists; Year: 1961; Format: Motion picture; Loma Linda, Calif.: The Dept., [1959?]

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Right indirect, incomplete, reducible inguinal hernia [motion picture] Source: [produced by Daniel L. Borden]; Year: 1917; Format: Motion picture; [Washington, D.C.]: Army Medical Museum, [1917]

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Technic for repair of an indirect inguinal hernia [motion picture] Source: John L. Madden; Year: 1969; Format: Motion picture; New York: Madden; Danbury, Ct.: for loan by Davis and Geck Film Library, 1969

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Transthoracic repair of sliding hiatus hernia with reflux esophagitis by the Mark IV technique [motion picture] Source: Arthur E. Baue. [et al.]; produced by Davis and Geck; Year: 1970; Format: Motion picture; Danbury, Conn.: Davis & Geck; [Atlanta: for loan by National Medical Audiovisual Center], 1970

Format:

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Traumatic left diaphragmatic hernia [motion picture] Source: [production company unknown]; S.W. Harrington; Year: 1935; Format: Motion picture; [S.l.: s.n., 1935]

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Umbilical hernia [videorecording] Source: Videosurgery; Year: 1977; Format: Videorecording; Don Mills, Ont.: Southam Business Publications, c1977

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CHAPTER 9. PERIODICALS AND NEWS ON HERNIA Overview In this chapter, we suggest a number of news sources and present various periodicals that cover hernia.

News Services and Press Releases One of the simplest ways of tracking press releases on hernia is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing.

PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “hernia” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance.

Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to hernia. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “hernia” (or synonyms). The following was recently listed in this archive for hernia: ·

Laparoscopic hernia repair decreases long-term complication rate Source: Reuters Medical News Date: May 09, 2003

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Titanium-coated mesh improves hernia repair Source: Reuters Industry Breifing Date: April 11, 2003

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Prince Charles needs hernia operation Source: Reuters Health eLine Date: March 11, 2003

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Surgeons use keyhole surgery for fetus's hernias Source: Reuters Health eLine Date: September 05, 2002

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Onux fixation device CE Mark certified for hernia surgeries Source: Reuters Industry Breifing Date: August 26, 2002

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Hiatal hernias less likely to recur when patch used during laparoscopic repair Source: Reuters Medical News Date: June 21, 2002

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Laparoscopic repair often most cost effective hernia treatment option Source: Reuters Industry Breifing Date: March 18, 2002

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GERD symptoms and hiatal hernia are risk factors for Barrett's esophagus Source: Reuters Medical News Date: January 29, 2002

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Prosthetic repair of umbilical hernia in adults associated with low recurrence rate Source: Reuters Medical News Date: October 31, 2001

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Endoscopic extraperitoneal repair of recurrent hernia safe, effective Source: Reuters Medical News Date: July 04, 2001

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Laparoscopic groin hernia repair sometimes, but not always, cost effective Source: Reuters Industry Breifing Date: June 22, 2001

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Ampicillin/sulbactam reduces hernia repair wound infection rate Source: Reuters Industry Breifing Date: February 14, 2001

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UK's NICE recommends against keyhole hernia repair Source: Reuters Industry Breifing Date: January 17, 2001

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Abdominal hernia size and location determine best surgical treatment Source: Reuters Medical News Date: October 31, 2000

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Laparoscopic procedure cuts recovery time for repair of giant paraesophageal hernia Source: Reuters Medical News Date: October 23, 2000

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Mesh repair superior to suture repair in reducing incisional hernia recurrence rate Source: Reuters Medical News Date: August 10, 2000

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Transperitoneal procedure recommended for endoscopic hernia repair Source: Reuters Medical News Date: June 21, 2000

Periodicals and News

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Prosthetic mesh used in hernia repair can be site of infection Source: Reuters Medical News Date: May 30, 2000

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Recurrence associated with laparoscopic repair of large type III hiatal hernia Source: Reuters Medical News Date: May 10, 2000

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Spinal anesthesia safe for preterm infants undergoing inguinal hernia repair Source: Reuters Medical News Date: April 26, 2000

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FDA approves Genzyme's novel surgical mesh for hernia repair Source: Reuters Medical News Date: March 23, 2000

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Progression of Barrett's esophagus related to presence of hiatal hernia Source: Reuters Medical News Date: December 24, 1999

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In utero myelomeningocele repair lowers incidence of hindbrain herniation in infants with spina bifida Source: Reuters Medical News Date: November 17, 1999

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Hiatal hernia, common cause of heartburn, may be inherited Source: Reuters Health eLine Date: October 22, 1999

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Laparoscopy for repair of groin hernia debated Source: Reuters Health eLine Date: July 19, 1999

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Laparoscopic repair of groin hernia called risky for nonspecialists Source: Reuters Medical News Date: July 16, 1999

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Sciatic hernia can cause pelvic pain Source: Reuters Health eLine Date: June 08, 1998

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Sciatic hernia may cause chronic pelvic pain Source: Reuters Medical News Date: June 03, 1998

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Laparoscopic Hernia Repair Shown Superior To Open Repair Source: Reuters Medical News Date: May 29, 1997

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Laparoscopic Hernia Repair Benefits Source: Reuters Health eLine Date: May 28, 1997

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Less Pain After New Hernia Repair Source: Reuters Health eLine Date: March 24, 1997

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Cancer And Diaphragmatic Hernia Featured At Surgeons' Meeting Source: Reuters Medical News Date: October 24, 1995

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Laparoscopic Versus Open Repair Of Inguinal Hernia Debated Source: Reuters Medical News Date: October 13, 1995

The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine.

Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name.

Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “hernia” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests.

Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “hernia” (or synonyms). If you know the name of a company that is relevant to hernia, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/.

BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “hernia” (or synonyms).

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Newsletter Articles Use the Combined Health Information Database, and limit your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” Type “hernia” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months. The following is a typical result when searching for newsletter articles on hernia: ·

Answers to Your Questions About Digestive Health: GERD, Hiatal Hernia, and Surgery Source: Digestive Health Matters. 4(3): 1-2. Fall 2002. Contact: Available from International Foundation for Functional Gastrointestinal Disorders (IFFGD). P.O. Box 170864, Milwaukee, WI 53217. (888) 964-2001 or (414) 9641799. Fax (414) 964-7176. Website: www.iffgd.org. Summary: This newsletter article answers a question from a reader who is coping with gastroesophageal reflux disease (GERD, the return of stomach acid back into the esophagus) and a hiatal hernia. The reader has been advised to have surgery for the hernia and is interested in finding out the impact of surgery on the GERD, as well as other risk factors. The author first explains the basic anatomy and physiology of the esophagus, the lower esophageal sphincter (LES), and the stomach, then describes how surgical therapy can correct the underlying physical anomalies. The author then describes postoperative complications, followup data from research studies on this type of surgery, and areas of controversy. One sidebar describes the laparoscopic approach to this type of surgery. The author concludes by explaining the circumstances in which surgery would be an appropriate answer to the problems described.

Academic Periodicals covering Hernia Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to hernia. In addition to these sources, you can search for articles covering hernia that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

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CHAPTER 10. RESEARCHING MEDICATIONS Overview While a number of hard copy or CD-ROM resources are available for researching medications, a more flexible method is to use Internet-based databases. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.

U.S. Pharmacopeia Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications recommended for hernia. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the U.S. Pharmacopeia (USP). Today, the USP is a non-profit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at http://www.usp.org/. The USP currently provides standards for over 3,700 medications. The resulting USP DIÒ Advice for the PatientÒ can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database, located at http://www.fda.gov/cder/da/da.htm. While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopeia (USP). Below, we have compiled a list of medications associated with hernia. If you would like more information on a particular medication, the provided hyperlinks will direct you to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The

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following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to hernia: Laxatives ·

Oral - U.S. Brands: Afko-Lube; Afko-Lube Lax 40; Agoral Marshmallow; Agoral Raspberry; Alaxin; Alophen; Alphamul; Alramucil Orange; Alramucil Regular; Bilagog; Bilax; Bisac-Evac; Black-Draught; Black-Draught Lax-Senna; Carter's Little Pills; Cholac; Chronulac; Cillium; Cit http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202319.html

Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. Or, you may be able to access these sources from your local medical library.

Mosby’s Drug ConsultÔ Mosby’s Drug ConsultÔ database (also available on CD-ROM and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Subscription information is available at the following hyperlink: http://www.mosbysdrugconsult.com/.

PDRhealth The PDRhealth database is a free-to-use, drug information search engine that has been written for the public in layman’s terms. It contains FDA-approved drug information adapted from the Physicians’ Desk Reference (PDR) database. PDRhealth can be searched by brand name, generic name, or indication. It features multiple drug interactions reports. Search PDRhealth at http://www.pdrhealth.com/drug_info/index.html.

Other Web Sites Drugs.com (www.drugs.com) reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. (http://www.medletter.com/) which allows users to download articles on various drugs and therapeutics for a nominal fee. If you have any questions about a medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1-888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.

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APPENDICES

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APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute12: ·

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

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National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

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National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

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National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

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National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

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National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

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National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

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National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

12

These publications are typically written by one or more of the various NIH Institutes.

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National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

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National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

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National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

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National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

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National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

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National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

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National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

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National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

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National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

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National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

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National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

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National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

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National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

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Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

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National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

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National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

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Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

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Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.13 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:14 ·

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

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HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

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NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

·

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

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Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

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Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

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Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

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Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

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Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

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MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

13 Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 14 See http://www.nlm.nih.gov/databases/databases.html.

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·

Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

·

Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html The Combined Health Information Database

A comprehensive source of information on clinical guidelines written for professionals is the Combined Health Information Database. You will need to limit your search to one of the following: Brochure/Pamphlet, Fact Sheet, or Information Package, and “hernia” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For the publication date, select “All Years.” Select your preferred language and the format option “Fact Sheet.” Type “hernia” (or synonyms) into the “For these words:” box. The following is a sample result: ·

Sensitive Gut: A Harvard Health Letter Special Report Source: Boston, MA: Harvard Medical School Health Publications Group. 1996. 39 p. Contact: Available from Harvard Medical School Health Publications Group. Department GUT, P.O. Box 380, Boston, MA 02117. (617) 432-1485. Fax (617) 432-1506. PRICE: $16.00 (as of 1996); bulk discounts available. Summary: This report focuses on five functional gastrointestinal (GI) disorders: gastroesophageal reflux disease (GERD), nonulcer dyspepsia, irritable bowel syndrome (IBS), constipation, and excessive gas. The author first introduces the anatomy and physiology of the GI tract, emphasizing the process of digestion. The following five sections present a discussion of the definition, causes, diagnosis, and therapy for each of the disorders. Specific topics include the hiatal hernia connection to GERD, antireflux drug therapy, surgery, Helicobacter pylori infection, psychological factors in dyspepsia, the role of stress in IBS, the types of constipation, belching, and flatulence. The report concludes with an overview of recommended good gut hygiene, an appendix summarizing drugs used to treat functional gastrointestinal disorders, and a glossary of terms. 10 figures. 5 tables.

The NLM Gateway15 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.16 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “hernia” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category.

15 16

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH).

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Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 32739 765 145 31 4 33684

HSTAT17 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.18 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.19 Simply search by “hernia” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

Coffee Break: Tutorials for Biologists20 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.21 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.22 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

17

Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html.

18

The HSTAT URL is http://hstat.nlm.nih.gov/.

19

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations. 20 Adapted from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html. 21 The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 22 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

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Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: ·

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

·

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

The Genome Project and Hernia In the following section, we will discuss databases and references which relate to the Genome Project and hernia.

Online Mendelian Inheritance in Man (OMIM) The Online Mendelian Inheritance in Man (OMIM) database is a catalog of human genes and genetic disorders authored and edited by Dr. Victor A. McKusick and his colleagues at Johns Hopkins and elsewhere. OMIM was developed for the World Wide Web by the National Center for Biotechnology Information (NCBI).23 The database contains textual information, pictures, and reference information. It also contains copious links to NCBI’s Entrez database of MEDLINE articles and sequence information. To search the database, go to http://www.ncbi.nlm.nih.gov/Omim/searchomim.html. Type “hernia” (or synonyms) into the search box, and click “Submit Search.” If too many results appear, you can narrow the search by adding the word “clinical.” Each report will have additional links to related research and databases. In particular, the option “Database Links” will search across technical databases that offer an abundance of information. The following is an example of the results you can obtain from the OMIM for hernia: ·

Acromegaloid Features, Overgrowth, Cleft Palate, and Hernia Web site: http://www.ncbi.nlm.nih.gov/htbin-post/Omim/dispmim?606049

·

Diverticulosis of Bowel, Hernia, and Retinal Detachment Web site: http://www.ncbi.nlm.nih.gov/htbin-post/Omim/dispmim?223330

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Epidermolysis Bullosa with Diaphragmatic Hernia Web site: http://www.ncbi.nlm.nih.gov/htbin-post/Omim/dispmim?226735

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Hernia, Anterior Diaphragmatic Web site: http://www.ncbi.nlm.nih.gov/htbin-post/Omim/dispmim?306950

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Hernia, Diaphragmatic Web site: http://www.ncbi.nlm.nih.gov/htbin-post/Omim/dispmim?142340

23 Adapted from http://www.ncbi.nlm.nih.gov/. Established in 1988 as a national resource for molecular biology information, NCBI creates public databases, conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information--all for the better understanding of molecular processes affecting human health and disease.

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Hernia, Double Inguinal Web site: http://www.ncbi.nlm.nih.gov/htbin-post/Omim/dispmim?142350

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Hernia, Hiatus Web site: http://www.ncbi.nlm.nih.gov/htbin-post/Omim/dispmim?142400

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Microcephaly, Hiatus Hernia, and Nephrotic Syndrome Web site: http://www.ncbi.nlm.nih.gov/htbin-post/Omim/dispmim?251300

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Microspherophakia with Hernia Web site: http://www.ncbi.nlm.nih.gov/htbin-post/Omim/dispmim?157150

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Sucrosuria, Hiatus Hernia and Mental Retardation Web site: http://www.ncbi.nlm.nih.gov/htbin-post/Omim/dispmim?272000

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Genes and Disease (NCBI - Map) The Genes and Disease database is produced by the National Center for Biotechnology Information of the National Library of Medicine at the National Institutes of Health. This Web site categorizes each disorder by system of the body. Go to http://www.ncbi.nlm.nih.gov/disease/, and browse the system pages to have a full view of important conditions linked to human genes. Since this site is regularly updated, you may wish to revisit it from time to time. The following systems and associated disorders are addressed: ·

Cancer: Uncontrolled cell division. Examples: Breast and ovarian cancer, Burkitt lymphoma, chronic myeloid leukemia, colon cancer, lung cancer, malignant melanoma, multiple endocrine neoplasia, neurofibromatosis, p53 tumor suppressor, pancreatic cancer, prostate cancer, Ras oncogene, RB: retinoblastoma, von Hippel-Lindau syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Cancer.html

·

Immune System: Fights invaders. Examples: Asthma, autoimmune polyglandular syndrome, Crohn’s disease, DiGeorge syndrome, familial Mediterranean fever, immunodeficiency with Hyper-IgM, severe combined immunodeficiency. Web site: http://www.ncbi.nlm.nih.gov/disease/Immune.html

·

Metabolism: Food and energy. Examples: Adreno-leukodystrophy, atherosclerosis, Best disease, Gaucher disease, glucose galactose malabsorption, gyrate atrophy, juvenile-onset diabetes, obesity, paroxysmal nocturnal hemoglobinuria, phenylketonuria, Refsum disease, Tangier disease, Tay-Sachs disease. Web site: http://www.ncbi.nlm.nih.gov/disease/Metabolism.html

·

Muscle and Bone: Movement and growth. Examples: Duchenne muscular dystrophy, Ellis-van Creveld syndrome, Marfan syndrome, myotonic dystrophy, spinal muscular atrophy. Web site: http://www.ncbi.nlm.nih.gov/disease/Muscle.html

·

Nervous System: Mind and body. Examples: Alzheimer disease, amyotrophic lateral sclerosis, Angelman syndrome, Charcot-Marie-Tooth disease, epilepsy, essential tremor, fragile X syndrome, Friedreich’s ataxia, Huntington disease, Niemann-Pick disease, Parkinson disease,

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Prader-Willi syndrome, Rett syndrome, spinocerebellar atrophy, Williams syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Brain.html ·

Signals: Cellular messages. Examples: Ataxia telangiectasia, Cockayne syndrome, glaucoma, male-patterned baldness, SRY: sex determination, tuberous sclerosis, Waardenburg syndrome, Werner syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Signals.html

·

Transporters: Pumps and channels. Examples: Cystic fibrosis, deafness, diastrophic dysplasia, Hemophilia A, long-QT syndrome, Menkes syndrome, Pendred syndrome, polycystic kidney disease, sickle cell anemia, Wilson’s disease, Zellweger syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Transporters.html

Entrez Entrez is a search and retrieval system that integrates several linked databases at the National Center for Biotechnology Information (NCBI). These databases include nucleotide sequences, protein sequences, macromolecular structures, whole genomes, and MEDLINE through PubMed. Entrez provides access to the following databases: ·

3D Domains: Domains from Entrez Structure, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo

·

Books: Online books, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=books

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Genome: Complete genome assemblies, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Genome

·

NCBI’s Protein Sequence Information Survey Results: Web site: http://www.ncbi.nlm.nih.gov/About/proteinsurvey/

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Nucleotide Sequence Database (Genbank): Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Nucleotide

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OMIM: Online Mendelian Inheritance in Man, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=OMIM

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PopSet: Population study data sets, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Popset

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ProbeSet: Gene Expression Omnibus (GEO), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo

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Protein Sequence Database: Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Protein

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PubMed: Biomedical literature (PubMed), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed

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Structure: Three-dimensional macromolecular structures, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Structure

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Taxonomy: Organisms in GenBank, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Taxonomy

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To access the Entrez system at the National Center for Biotechnology Information, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=genome, and then select the database that you would like to search. The databases available are listed in the drop box next to “Search.” Enter “hernia” (or synonyms) into the search box and click “Go.”

Jablonski’s Multiple Congenital Anomaly/Mental Retardation (MCA/MR) Syndromes Database24 This online resource has been developed to facilitate the identification and differentiation of syndromic entities. Special attention is given to the type of information that is usually limited or completely omitted in existing reference sources due to space limitations of the printed form. At http://www.nlm.nih.gov/mesh/jablonski/syndrome_toc/toc_a.html, you can search across syndromes using an alphabetical index. Search by keywords at http://www.nlm.nih.gov/mesh/jablonski/syndrome_db.html. The Genome Database25 Established at Johns Hopkins University in Baltimore, Maryland in 1990, the Genome Database (GDB) is the official central repository for genomic mapping data resulting from the Human Genome Initiative. In the spring of 1999, the Bioinformatics Supercomputing Centre (BiSC) at the Hospital for Sick Children in Toronto, Ontario assumed the management of GDB. The Human Genome Initiative is a worldwide research effort focusing on structural analysis of human DNA to determine the location and sequence of the estimated 100,000 human genes. In support of this project, GDB stores and curates data generated by researchers worldwide who are engaged in the mapping effort of the Human Genome Project (HGP). GDB’s mission is to provide scientists with an encyclopedia of the human genome which is continually revised and updated to reflect the current state of scientific knowledge. Although GDB has historically focused on gene mapping, its focus will broaden as the Genome Project moves from mapping to sequence, and finally, to functional analysis. To access the GDB, simply go to the following hyperlink: http://www.gdb.org/. Search “All Biological Data” by “Keyword.” Type “hernia” (or synonyms) into the search box, and review the results. If more than one word is used in the search box, then separate each one with the word “and” or “or” (using “or” might be useful when using synonyms).

24 Adapted from the National Library of Medicine: http://www.nlm.nih.gov/mesh/jablonski/about_syndrome.html. 25 Adapted from the Genome Database: http://gdbwww.gdb.org/gdb/aboutGDB.html - mission.

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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on hernia can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to hernia. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly.

The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below.

Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to hernia. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “hernia”:

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·

Other guides Birth Defects http://www.nlm.nih.gov/medlineplus/birthdefects.html Breast Cancer http://www.nlm.nih.gov/medlineplus/breastcancer.html Gastroesophageal Reflux/Hiatal Hernia http://www.nlm.nih.gov/medlineplus/gastroesophagealrefluxhiatalhernia.html Lymphoma http://www.nlm.nih.gov/medlineplus/lymphoma.html Male Genital Disorders http://www.nlm.nih.gov/medlineplus/malegenitaldisorders.html Testicular Cancer http://www.nlm.nih.gov/medlineplus/testicularcancer.html

Within the health topic page dedicated to hernia, the following was listed: ·

General/Overview Causes and Surgical Treatment of Abdominal Hernia Source: American Medical Association http://www.medem.com/medlb/article_detaillb.cfm?article_ID=ZZZESG4TWAC &sub_cat=195

·

Diagnosis/Symptoms Coughing During Hernia Exam Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=HQ00491

·

Treatment Hernia Repair Source: American College of Surgeons http://www.medem.com/search/article_display.cfm?path=n:&mstr=/ZZZBTQW1 RWC.html&soc=ACS&srch_typ=NAV_SERCH Laparoscopic Hernia Repair: Less Invasive, Faster Healing Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=HQ00980

·

Specific Conditions/Aspects Diaphragmatic Hernia Source: Children's Hospital Boston http://www.childrenshospital.org/cfapps/A2ZtopicDisplay.cfm?Topic=Diaphrag matic%2520Hernia Incisional Hernia http://www.nlm.nih.gov/medlineplus/tutorials/incisionalhernialoader.html

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Inguinal Hernia http://www.nlm.nih.gov/medlineplus/tutorials/inguinalhernialoader.html Inguinal Hernia Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=DS00364 Umbilical Hernia http://www.nlm.nih.gov/medlineplus/tutorials/umbilicalhernialoader.html Umbilical Hernia Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=AN00270 ·

Children Congenital Diaphragmatic Hernia (CDH) Source: Children's Hospital Boston http://www.childrenshospital.org/cfapps/A2ZtopicDisplay.cfm?Topic=Congenita l%2520Diaphragmatic%2520Hernia%2520%2528CDH%2529 Could That Lump Be a Hernia? Source: Nemours Foundation http://kidshealth.org/parent/system/surgical/hernia.html Hernia (Umbilical / Inguinal) Source: Children's Hospital Boston http://www.childrenshospital.org/cfapps/A2ZtopicDisplay.cfm?Topic=Hernia%2 520%2528Umbilical%2520%252F%2520Inguinal%2529

·

From the National Institutes of Health Inguinal Hernia Source: National Digestive Diseases Information Clearinghouse http://digestive.niddk.nih.gov/ddiseases/pubs/inguinalhernia/index.htm

·

Organizations National Digestive Diseases Information Clearinghouse http://digestive.niddk.nih.gov/ National Institute of Diabetes and Digestive and Kidney Diseases http://www.niddk.nih.gov/

·

Teenagers Hernias Source: Nemours Foundation http://kidshealth.org/teen/diseases_conditions/digestive/hernias.html

You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating

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unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on hernia. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: ·

Hernia Source: Emeryville, CA: Parlay International. 1995. [4 p.]. Contact: Available from Parlay International. Box 8817, Emeryville, CA 94662-0817. (800) 457-2752. Website: www.parlay.com. PRICE: $20.00 per package of 50. Order number: 7045. Summary: A hernia is a protrusion of an organ or part of an organ through the cavity wall that contains it. Hernias may be congenital (occurring at birth) or acquired (frequently brought on by strenuous activity). This brochure offers basic information about hernias, noting that most patients who have undergone surgery for hernia can usually resume normal activities within 2 to 3 weeks. The brochure discusses the symptoms, treatment options, postoperative care, and recovery issues. The most common symptom of a hernia is pain. Some hernias, such as hiatal hernias, are often managed by medication and dietary changes. However, most hernias in the groin and navel areas require surgical repair. The brochure includes a chart of four types of common hernias and their causes: inguinal hernia, paraumbilical hernia, hiatal hernia, and incisional hernia. The brochure is illustrated with full color photographs of active people.

·

Same Day Surgery: Hernia Repair Source: Waco, TX: Health Edco. 1991. 2 p. Contact: Available from Health Edco. P.O. Box 21207, Waco, TX 76702-1207. (800) 2993366, ext. 295. Fax (817) 751-0221. PRICE: $2.00 each for 1-99 copies, $0.43 each for 100199 copies. Summary: This brochure describes hernia conditions that can be corrected by same day surgery. The symptoms of a hernia are usually a bulge under the skin and pain when lifting, coughing, or straining in some way. A hernia happens when a torn or weakened wall, usually in the abdominal cavity, lets the inner structure, such as a loop of intestine, slip through into a hernial sac. This causes pain, and can be quite serious if not taken care of promptly; the hernia can become strangulated and gangrenous. In hernia repair, the doctor returns the contents of the hernial sac to the body cavity, and repairs the torn or weakened wall. The brochure outlines recommended preoperative care strategies, what to expect the day of the surgery, the types of surgical techniques used to treat each hernia condition, and postoperative healing at home. The tissues surrounding the incision may be tender and discolored, which is normal. However, the patient should contact the doctor if there is bleeding from the incision site, a fever of 101 degrees or

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higher, severe pain, or inability to urinate. Full color line drawings illustrate a common hernia and the surgery used to treat it. 4 figures. ·

When You Need an Operation: About Hernia Repair Source: Chicago, IL: American College of Surgeons. 1994. 4 p. Contact: Available from American College of Surgeons. 55 East Erie Street, Chicago, IL 60611. (312) 664-4050 PRICE: $14 for 50 copies, $27 for 100 copies. Summary: This brochure provides information for patients scheduled to undergo hernia repair or herniorrhaphy. Written in a question and answer format, the brochure explains why the procedure may be recommended; how hernias develop; symptoms of hernias and the types of activity associate with the appearance of an inguinal hernia; preparing for the operation; outpatient surgery; the types of surgical procedures, including the conventional method, the tension-free mesh technique, and laparoscopic techniques; recovery from the operation; and possible complications. The brochure concludes with a description of the specialized training required for surgeons and for certification as a Fellow of the American College of Surgeons. 1 figure.

·

Guide to Parents: Hernias, Hydroceles and Undescended Testicles Source: Washington, DC: Children's National Medical Center. 1994. 2 p. Contact: Available from Children's National Medical Center. Department of Pediatric Urology, 111 Michigan Avenue, N.W., Washington, DC 20010-2970. (202) 884-5042. PRICE: Single copy free. Summary: This brochure, written for parents, provides an overview of the problems of hernias, hydroceles, and undescended testicles in children. Topics include the anatomy and function of the testicles; a definition of inguinal hernia, hydroceles, and undescended testicles; and a description of the surgery used to correct each of these problems. Additional sections briefly discuss care after surgery and postoperative visits. 4 figures.

·

Hiatal Hernia Source: in Sodeman, W.A., Jr. Instructions for Geriatric Patients. Philadelphia, PA: W.B. Saunders Company. 1995. p. 105-106. Contact: Available from W.B. Saunders Company. Order Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887. (800) 545-2522. Fax (800) 874-6418 or (407) 352-3445. PRICE: $38.95. ISBN: 0721643353. Summary: This chapter, from a book of instructions for geriatric patients, provides a basic information sheet on hiatal hernia. A hiatal hernia occurs when the stomach protrudes through the opening in the diaphragm. Sliding hiatal hernia seems to occur with increasing frequency in elderly patients. Reflux of acid into the esophagus is common with a sliding hiatal hernia. The information sheet reviews treatment options, including elevating the head of the bed, avoiding food and drink for 2 hours before going to bed, not wearing tight or restricting garments, and not bending over to pick up objects from the floor. The information sheet notes that, in addition to these lifestyle modifications, patients may be placed on medications that can decrease the acid production in the stomach, neutralize the acid, or strengthen the muscle in the lower esophagus to prevent reflux. The information sheet concludes by reminding readers to contact their health care provider if they experience frequent, persistent heartburn, if

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they experience regurgitation of food into the mouth, or if they awaken with a bitter taste in the mouth or hoarseness. The instructions are designed to supplement and reinforce physician instructions to their patients. (AA-M). ·

Gastroesophageal Disease (Hiatal Hernia and Heartburn) Source: Bethesda, MD: National Digestive Diseases Information Clearinghouse. 2001. 6 p. Contact: Available from National Digestive Diseases Information Clearinghouse (NDDIC). 2 Information Way, Bethesda, MD 20892-3570. (800) 891-5389 or (301) 6543810. Fax (301) 634-0716. E-mail: [email protected]. Website: www.niddk.nih.gov. PRICE: Full-text available online at no charge; single copy free; bulk copies available. Order number: DD-160. Summary: This fact sheet provides information on gastroesophageal reflux disease (GERD), a digestive disorder that affects the lower esophageal sphincter (LES) that connects the esophagus with the stomach. Written in a question-and-answer format, the fact sheet addresses causes, symptoms, treatment, and long-term complications of GERD. Specific topics include the role of hiatal hernia; how dietary and lifestyle choices may contribute to GERD; heartburn pain and how to control it; non-pharmaceutical treatment options for GERD; and diagnostic tests used to establish a diagnosis of GERD, including upper GI series, endoscopy, the Bernstein test, and esophageal manometry. The fact sheet also includes a description of the National Digestive Diseases Information Clearinghouse. 2 figures. 4 references.

·

Hiatus Hernia. [La Hernia de Hiato] Source: Camp Hill, PA: Chek-Med Systems, Inc. 1996. 2 p. Contact: Available from Chek-Med Systems, Inc. 200 Grandview Avenue, Camp Hill, PA 17011. (800) 451-5797. Fax (717) 761-0216. PRICE: $22 per pack of 50 pamphlets for order of 3-10 packs; 3 packet minimum. Discounts available for larger quantities and complete kits of gastroenterology pamphlets. Summary: This patient brochure, available in English and Spanish, provides information about the causes, types, symptoms, diagnosis, complications, and treatment of hiatus hernia, characterized by a hiatus or hole in the diaphragm through which a portion of the stomach herniates or passes up into the chest cavity. In most cases, hiatus hernias cause few or no symptoms. Complicated or serious hiatus hernia is relatively uncommon, but it is a situation in which a large portion of the stomach is up in the chest and results in medical problems which frequently require surgery. Diagnosis of hiatus hernia is typically made through an upper gastrointestinal tract barium X-ray exam and by complementary gastroscopy or endoscopy. Complications include chronic heartburn and inflammation of the lower esophagus and anemia due to chronic bleeding. Practical guidelines are outlined for treatment, which is only called for when the hernia results in symptoms such as persistent heartburn or difficulty in swallowing.

·

Hiatal Hernia: Understanding a Common Problem Source: San Bruno, CA: StayWell Company. 1999. [2 p.]. Contact: Available from StayWell Company. Order Department, 1100 Grundy Lane, San Bruno, CA 94066-9821. (800) 333-3032. Fax (650) 244-4512. E-mail: [email protected]. Website: www.staywell.com. PRICE: $17.95 for pack of 50; plus shipping and handling.

Patient Resources

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Summary: This patient education brochure describes hiatal hernia and its treatment. Written in nontechnical language, the brochure first describes hiatal hernia as a common problem that occurs when the stomach bulges into the chest. Most hiatal hernias cause no symptoms and need no treatment. Sometimes, hiatal hernias can cause reflux (return) of the gastric acid in the stomach back up into the esophagus. In these cases, symptoms can include heartburn or other chest discomfort; frequent burping; acid taste in the mouth; problems swallowing; and nighttime choking, coughing, or wheezing. Often a hiatal hernia is found during an examination or tests for another health problem. Diagnosis will include the patient's medical history and some diagnostic tests such as upper GI barium x ray, endoscopy, esophageal manometry, and 24 hour acid (pH) monitoring. Most treatment plans focus on lifestyle and behavior changes including: lose excess weight, avoid LES (lower esophageal sphincter) relaxers, avoid foods or drinks that cause symptoms, and try acid reducing medications. The brochure notes that surgery is rarely needed to treat hiatal hernias. One section of the brochure illustrates and describes the physiology of the connection between the esophagus and stomach (the LES) and what happens in hiatal hernia. The last page of the brochure summarizes strategies for coping with a hiatal hernia. The brochure is illustrated with full color line drawings. 8 figures. ·

All About Heartburn and Hiatus Hernia Source: London, England: British Digestive Foundation. 1993. 3 p. Contact: Available from British Digestive Foundation. 7 Chandos Street, London W1A 2LN England. PRICE: Single copy free. Summary: This patient education brochure provides basic information about heartburn and hiatus hernia. Written in a question-and-answer format, it covers topics including definitions of heartburn and hiatus hernia; the causes of heartburn; how hiatus hernia is treated; symptoms; and how to avoid heartburn. Specific suggestions for weight loss, diet, sleeping, posture, clothing, and pregnancy are given. The brochure includes an insert summarizing guidelines for the early diagnosis of digestive disorders. This insert, entitled 'When Should I See My Doctor' lists symptoms that suggest a health care provider should be consulted. The brochure concludes with a brief description of the activities of the British Digestive Foundation.

The National Guideline Clearinghouse™ The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search this site located at http://www.guideline.gov/ by using the keyword “hernia” (or synonyms). The following was recently posted: ·

Herniated disc. In: North American Spine Society phase III clinical guidelines for multidisciplinary spine care specialists Source: North American Spine Society - Medical Specialty Society; 2000; 104 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2803&nbr=2029&a mp;string=hernia

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·

Surgical repair of groin hernias Source: Society for Surgery of the Alimentary Tract, Inc - Medical Specialty Society; 1996 (revised 2000); 3 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2172&nbr=1398&a mp;string=hernia

Healthfinder™ Healthfinder™ is sponsored by the U.S. Department of Health and Human Services and offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: ·

Gastroesophageal Reflux Disease: (Hiatal Hernia and Heartburn) Summary: Gastroesophageal reflux disease (GERD) is a digestive disorder that affects the lower esophageal sphincter (LES)--the muscle connecting the esophagus with the stomach. Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=736

·

Hernia Information Home Page Summary: This web site covers all kinds of hernias and provides information by leading specialist on tension-free hernia repair surgery. Source: Nonprofit/Professional Entity--Follow the Resource URL for More Information http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=3897 The NIH Search Utility

The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to hernia. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html.

Additional Web Sources

A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: ·

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

Patient Resources

·

Family Village: http://www.familyvillage.wisc.edu/specific.htm

·

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

·

Med Help International: http://www.medhelp.org/HealthTopics/A.html

·

Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

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Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

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WebMDÒHealth: http://my.webmd.com/health_topics

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Associations and Hernia The following is a list of associations that provide information on and resources relating to hernia: ·

CHERUBS - The Association of Congenital Diaphragmatic Hernia Research, Advocacy and Support Telephone: (919) 693-8158 Fax: (707) 924-1114 Email: [email protected] Web Site: www.cherubs-cdh.org Background: CHERUBS - The Association of Congenital Diaphragmatic Hernia Research, Advocacy and Support is an international support group for the families of children who are born with Congenital Diaphragmatic Hernias (CDH) and their caregivers and physicians. Congenital Diaphragmatic Hernia is a rare condition that is present at birth and characterized by the protrusion of organs from the abdomen into the chest through an abnormal opening (hernia) in the muscle that divides the chest from the abdominal cavity. Established in 1993, CHERUBS is a volunteer organization associated with the March of Dimes, the Association of Birth Defect Children, Inc., and the California Birth Defects Monitoring Program. The Association serves people in the United States, Canada, Great Britain, and Ireland. CHERUBS offers a 'Parent Reference Guide,' periodic newsletters, and brochures; has a parent-to-parent matchup program; and provides referrals. Memberships are available, although medical professionals are asked to pay a one-time fee. In addition, the organization maintains a research library and compiles data from research surveys (e.g., Congenital Diaphragmatic Hernia Research Survey).

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to hernia. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with hernia.

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The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about hernia. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797.

Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “hernia” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information.

The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “hernia”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “hernia” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “hernia” (or a synonym) into the search box, and click “Submit Query.”

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APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.26

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

26

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)27: ·

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

·

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

·

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

·

California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

·

California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

·

California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

·

California: Gateway Health Library (Sutter Gould Medical Foundation)

·

California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

·

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

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California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

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California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

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California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

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California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

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California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

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California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

·

Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

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Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

·

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

27

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

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·

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

·

Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

·

Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

·

Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

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Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

·

Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

·

Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

·

Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

·

Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

·

Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

·

Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

·

Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

·

Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

·

Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

·

Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

·

Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

·

Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

·

Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

·

Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

·

Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

242 Hernia

·

Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

·

Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

·

Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

·

Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

·

Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

·

Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

·

Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

·

Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

·

Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

·

Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

·

Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

·

Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

·

Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

·

Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

·

Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

·

Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

·

National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

·

National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

·

National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

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·

Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

·

New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

·

New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

·

New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

·

New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

·

New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

·

New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

·

New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

·

New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

·

Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

·

Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

·

Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

·

Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

·

Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

·

Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

·

Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

·

Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

·

Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

·

Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

·

Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

244 Hernia

·

South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

·

Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

·

Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

·

Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

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ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: ·

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

·

MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

·

Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

·

Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

·

On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

·

Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

·

Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a). The NIH suggests the following Web sites in the ADAM Medical Encyclopedia when searching for information on hernia: ·

Basic Guidelines for Hernia Groin lump Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003100.htm Hernia repair Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002940.htm Herniated nucleus pulposus (slipped disk) Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000442.htm

·

Signs & Symptoms for Hernia Back pain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003108.htm Coughing Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003072.htm

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Enlarged lymph glands Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003097.htm Hernia Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003100.htm Leg pain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003182.htm Loss of movement Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003190.htm Low back pain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003108.htm Muscle weakness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003174.htm Neck pain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003025.htm Numbness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003206.htm Swelling Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003103.htm Tingling Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003206.htm ·

Diagnostics and Tests for Hernia Blood differential Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003657.htm CBC Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003642.htm EMG Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003929.htm Liver function tests Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003436.htm Liver-spleen scan Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003825.htm Lymph node biopsy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003933.htm Myelogram Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003807.htm

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Nerve conduction velocity Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003927.htm Spine CT Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003787.htm Spine MRI Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003792.htm Spine X-ray Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003806.htm X-ray Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003337.htm ·

Background Topics for Hernia Allergic reaction Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000005.htm Blood clots Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001124.htm Central Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002311.htm Chronic Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002312.htm Enzyme Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002353.htm Kidney function tests Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003435.htm Lymphangiography Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003798.htm Malignancy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002253.htm Palpation Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002284.htm Physical activity Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001941.htm Physical examination Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002274.htm Scrotum Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002296.htm

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Strain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000042.htm Weight control Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001943.htm Wound Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000043.htm

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: ·

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

·

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

·

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

·

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

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HERNIA DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abdominal Pain: Sensation of discomfort, distress, or agony in the abdominal region. [NIH] Aberrant: Wandering or deviating from the usual or normal course. [EU] Ablate: In surgery, is to remove. [NIH] Ablation: The removal of an organ by surgery. [NIH] Abscess: Accumulation of purulent material in tissues, organs, or circumscribed spaces, usually associated with signs of infection. [NIH] Acceptor: A substance which, while normally not oxidized by oxygen or reduced by hydrogen, can be oxidized or reduced in presence of a substance which is itself undergoing oxidation or reduction. [NIH] Acetaminophen: Analgesic antipyretic derivative of acetanilide. It has weak antiinflammatory properties and is used as a common analgesic, but may cause liver, blood cell, and kidney damage. [NIH] Acetylcarnitine: An acetic acid ester of carnitine that facilitates movement of acetyl CoA into the matrices of mammalian mitochondria during the oxidation of fatty acids. [NIH] Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Acidity: The quality of being acid or sour; containing acid (hydrogen ions). [EU] Acyl: Chemical signal used by bacteria to communicate. [NIH] Adaptability: Ability to develop some form of tolerance to conditions extremely different from those under which a living organism evolved. [NIH] Adenocarcinoma: A malignant epithelial tumor with a glandular organization. [NIH] Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Adhesions: Pathological processes consisting of the union of the opposing surfaces of a wound. [NIH] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU]

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Adverse Effect: An unwanted side effect of treatment. [NIH] Aerophagia: A condition that occurs when a person swallows too much air. Causes gas and frequent belching. [NIH] Aerosol: A solution of a drug which can be atomized into a fine mist for inhalation therapy. [EU]

Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Agar: A complex sulfated polymer of galactose units, extracted from Gelidium cartilagineum, Gracilaria confervoides, and related red algae. It is used as a gel in the preparation of solid culture media for microorganisms, as a bulk laxative, in making emulsions, and as a supporting medium for immunodiffusion and immunoelectrophoresis. [NIH]

Agenesis: Lack of complete or normal development; congenital absence of an organ or part. [NIH]

Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Airway: A device for securing unobstructed passage of air into and out of the lungs during general anesthesia. [NIH] Alendronate: A nonhormonal medication for the treatment of postmenopausal osteoporosis in women. This drug builds healthy bone, restoring some of the bone loss as a result of osteoporosis. [NIH] Alertness: A state of readiness to detect and respond to certain specified small changes occurring at random intervals in the environment. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Alkaline: Having the reactions of an alkali. [EU] Alkaloid: A member of a large group of chemicals that are made by plants and have nitrogen in them. Some alkaloids have been shown to work against cancer. [NIH] Allogeneic: Taken from different individuals of the same species. [NIH] Allograft: An organ or tissue transplant between two humans. [NIH] Alpha Particles: Positively charged particles composed of two protons and two neutrons, i.e., helium nuclei, emitted during disintegration of very heavy isotopes; a beam of alpha particles or an alpha ray has very strong ionizing power, but weak penetrability. [NIH] Alpha-Linolenic Acid: A fatty acid that is found in plants and involved in the formation of prostaglandins. [NIH]

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Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Alveoli: Tiny air sacs at the end of the bronchioles in the lungs. [NIH] Ambulant: Walking or able to walk. [EU] Amino acid: Any organic compound containing an amino (-NH2 and a carboxyl (- COOH) group. The 20 a-amino acids listed in the accompanying table are the amino acids from which proteins are synthesized by formation of peptide bonds during ribosomal translation of messenger RNA; all except glycine, which is not optically active, have the L configuration. Other amino acids occurring in proteins, such as hydroxyproline in collagen, are formed by posttranslational enzymatic modification of amino acids residues in polypeptide chains. There are also several important amino acids, such as the neurotransmitter y-aminobutyric acid, that have no relation to proteins. Abbreviated AA. [EU] Amphetamines: Analogs or derivatives of amphetamine. Many are sympathomimetics and central nervous system stimulators causing excitation, vasopression, bronchodilation, and to varying degrees, anorexia, analepsis, nasal decongestion, and some smooth muscle relaxation. [NIH] Ampicillin: Semi-synthetic derivative of penicillin that functions as an orally active broadspectrum antibiotic. [NIH] Ampulla: A sac-like enlargement of a canal or duct. [NIH] Anaesthesia: Loss of feeling or sensation. Although the term is used for loss of tactile sensibility, or of any of the other senses, it is applied especially to loss of the sensation of pain, as it is induced to permit performance of surgery or other painful procedures. [EU] Anaesthetic: 1. Pertaining to, characterized by, or producing anaesthesia. 2. A drug or agent that is used to abolish the sensation of pain. [EU] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Analogous: Resembling or similar in some respects, as in function or appearance, but not in origin or development;. [EU] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Anesthetics: Agents that are capable of inducing a total or partial loss of sensation, especially tactile sensation and pain. They may act to induce general anesthesia, in which an unconscious state is achieved, or may act locally to induce numbness or lack of sensation at a targeted site. [NIH] Aneurysm: A sac formed by the dilatation of the wall of an artery, a vein, or the heart. [NIH] Angina: Chest pain that originates in the heart. [NIH] Angina Pectoris: The symptom of paroxysmal pain consequent to myocardial ischemia usually of distinctive character, location and radiation, and provoked by a transient stressful situation during which the oxygen requirements of the myocardium exceed the capacity of

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the coronary circulation to supply it. [NIH] Angiogenesis: Blood vessel formation. Tumor angiogenesis is the growth of blood vessels from surrounding tissue to a solid tumor. This is caused by the release of chemicals by the tumor. [NIH] Animal model: An animal with a disease either the same as or like a disease in humans. Animal models are used to study the development and progression of diseases and to test new treatments before they are given to humans. Animals with transplanted human cancers or other tissues are called xenograft models. [NIH] Ankle: That part of the lower limb directly above the foot. [NIH] Anomalies: Birth defects; abnormalities. [NIH] Antagonism: Interference with, or inhibition of, the growth of a living organism by another living organism, due either to creation of unfavorable conditions (e. g. exhaustion of food supplies) or to production of a specific antibiotic substance (e. g. penicillin). [NIH] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

Antibiotic Prophylaxis: Use of antibiotics before, during, or after a diagnostic, therapeutic, or surgical procedure to prevent infectious complications. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Anti-Inflammatory Agents: Substances that reduce or suppress inflammation. [NIH] Antioxidant: A substance that prevents damage caused by free radicals. Free radicals are highly reactive chemicals that often contain oxygen. They are produced when molecules are split to give products that have unpaired electrons. This process is called oxidation. [NIH] Antipyretic: An agent that relieves or reduces fever. Called also antifebrile, antithermic and febrifuge. [EU] Anus: The opening of the rectum to the outside of the body. [NIH] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Aorta: The main trunk of the systemic arteries. [NIH] Aperture: A natural hole of perforation, especially one in a bone. [NIH] Aplasia: Lack of development of an organ or tissue, or of the cellular products from an organ or tissue. [EU] Apnea: A transient absence of spontaneous respiration. [NIH]

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Aponeurosis: Tendinous expansion consisting of a fibrous or membranous sheath which serves as a fascia to enclose or bind a group of muscles. [NIH] Apoptosis: One of the two mechanisms by which cell death occurs (the other being the pathological process of necrosis). Apoptosis is the mechanism responsible for the physiological deletion of cells and appears to be intrinsically programmed. It is characterized by distinctive morphologic changes in the nucleus and cytoplasm, chromatin cleavage at regularly spaced sites, and the endonucleolytic cleavage of genomic DNA (DNA fragmentation) at internucleosomal sites. This mode of cell death serves as a balance to mitosis in regulating the size of animal tissues and in mediating pathologic processes associated with tumor growth. [NIH] Appendicitis: Acute inflammation of the vermiform appendix. [NIH] Aqueous: Having to do with water. [NIH] Arachidonic Acid: An unsaturated, essential fatty acid. It is found in animal and human fat as well as in the liver, brain, and glandular organs, and is a constituent of animal phosphatides. It is formed by the synthesis from dietary linoleic acid and is a precursor in the biosynthesis of prostaglandins, thromboxanes, and leukotrienes. [NIH] Arginine: An essential amino acid that is physiologically active in the L-form. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Arteriosus: Circle composed of anastomosing arteries derived from two long posterior ciliary and seven anterior ciliary arteries, located in the ciliary body about the root of the iris. [NIH]

Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH] Arthropathy: Any joint disease. [EU] Asphyxia: A pathological condition caused by lack of oxygen, manifested in impending or actual cessation of life. [NIH] Aspiration: The act of inhaling. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Asthenia: Clinical sign or symptom manifested as debility, or lack or loss of strength and energy. [NIH] Asymptomatic: Having no signs or symptoms of disease. [NIH] Ataxia: Impairment of the ability to perform smoothly coordinated voluntary movements. This condition may affect the limbs, trunk, eyes, pharnyx, larnyx, and other structures. Ataxia may result from impaired sensory or motor function. Sensory ataxia may result from posterior column injury or peripheral nerve diseases. Motor ataxia may be associated with cerebellar diseases; cerebral cortex diseases; thalamic diseases; basal ganglia diseases; injury to the red nucleus; and other conditions. [NIH] Atresia: Lack of a normal opening from the esophagus, intestines, or anus. [NIH] Atrial: Pertaining to an atrium. [EU] Atrophy: Decrease in the size of a cell, tissue, organ, or multiple organs, associated with a variety of pathological conditions such as abnormal cellular changes, ischemia, malnutrition, or hormonal changes. [NIH]

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Autodigestion: Autolysis; a condition found in disease of the stomach: the stomach wall is digested by the gastric juice. [NIH] Autologous: Taken from an individual's own tissues, cells, or DNA. [NIH] Autopsy: Postmortem examination of the body. [NIH] Avian: A plasmodial infection in birds. [NIH] Axonal: Condition associated with metabolic derangement of the entire neuron and is manifest by degeneration of the distal portion of the nerve fiber. [NIH] Axons: Nerve fibers that are capable of rapidly conducting impulses away from the neuron cell body. [NIH] Back Pain: Acute or chronic pain located in the posterior regions of the trunk, including the thoracic, lumbar, sacral, or adjacent regions. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacteriophage: A virus whose host is a bacterial cell; A virus that exclusively infects bacteria. It generally has a protein coat surrounding the genome (DNA or RNA). One of the coliphages most extensively studied is the lambda phage, which is also one of the most important. [NIH] Barium: An element of the alkaline earth group of metals. It has an atomic symbol Ba, atomic number 56, and atomic weight 138. All of its acid-soluble salts are poisonous. [NIH] Basal Ganglia: Large subcortical nuclear masses derived from the telencephalon and located in the basal regions of the cerebral hemispheres. [NIH] Basal Ganglia Diseases: Diseases of the basal ganglia including the putamen; globus pallidus; claustrum; amygdala; and caudate nucleus. Dyskinesias (most notably involuntary movements and alterations of the rate of movement) represent the primary clinical manifestations of these disorders. Common etiologies include cerebrovascular disease; neurodegenerative diseases; and craniocerebral trauma. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Basement Membrane: Ubiquitous supportive tissue adjacent to epithelium and around smooth and striated muscle cells. This tissue contains intrinsic macromolecular components such as collagen, laminin, and sulfated proteoglycans. As seen by light microscopy one of its subdivisions is the basal (basement) lamina. [NIH] Belching: Noisy release of gas from the stomach through the mouth. Also called burping. [NIH]

Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Beta-Lactamases: Enzymes found in many bacteria which catalyze the hydrolysis of the amide bond in the beta-lactam ring. Well known antibiotics destroyed by these enzymes are penicillins and cephalosporins. EC 3.5.2.6. [NIH] Bifida: A defect in development of the vertebral column in which there is a central deficiency of the vertebral lamina. [NIH] Bilateral: Affecting both the right and left side of body. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its

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composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Bile Acids: Acids made by the liver that work with bile to break down fats. [NIH] Bile duct: A tube through which bile passes in and out of the liver. [NIH] Bile Pigments: Pigments that give a characteristic color to bile including: bilirubin, biliverdine, and bilicyanin. [NIH] Biliary: Having to do with the liver, bile ducts, and/or gallbladder. [NIH] Biliary Tract: The gallbladder and its ducts. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biological therapy: Treatment to stimulate or restore the ability of the immune system to fight infection and disease. Also used to lessen side effects that may be caused by some cancer treatments. Also known as immunotherapy, biotherapy, or biological response modifier (BRM) therapy. [NIH] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Bladder: The organ that stores urine. [NIH] Bloating: Fullness or swelling in the abdomen that often occurs after meals. [NIH] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood Platelets: Non-nucleated disk-shaped cells formed in the megakaryocyte and found in the blood of all mammals. They are mainly involved in blood coagulation. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Body Image: Individuals' personal concept of their bodies as objects in and bound by space, independently and apart from all other objects. [NIH] Body Mass Index: One of the anthropometric measures of body mass; it has the highest correlation with skinfold thickness or body density. [NIH] Bolus: A single dose of drug usually injected into a blood vessel over a short period of time. Also called bolus infusion. [NIH] Bolus infusion: A single dose of drug usually injected into a blood vessel over a short period of time. Also called bolus. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists

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mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bone scan: A technique to create images of bones on a computer screen or on film. A small amount of radioactive material is injected into a blood vessel and travels through the bloodstream; it collects in the bones and is detected by a scanner. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Bradykinin: A nonapeptide messenger that is enzymatically produced from kallidin in the blood where it is a potent but short-lived agent of arteriolar dilation and increased capillary permeability. Bradykinin is also released from mast cells during asthma attacks, from gut walls as a gastrointestinal vasodilator, from damaged tissues as a pain signal, and may be a neurotransmitter. [NIH] Brain Stem: The part of the brain that connects the cerebral hemispheres with the spinal cord. It consists of the mesencephalon, pons, and medulla oblongata. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

Breakdown: A physical, metal, or nervous collapse. [NIH] Breast reconstruction: Surgery to rebuild a breast's shape after a mastectomy. [NIH] Broad Ligament: A broad fold of peritoneum that extends from the side of the uterus to the wall of the pelvis. [NIH] Broad-spectrum: Effective against a wide range of microorganisms; said of an antibiotic. [EU] Bronchi: The larger air passages of the lungs arising from the terminal bifurcation of the trachea. [NIH] Bronchial: Pertaining to one or more bronchi. [EU] Bronchopulmonary: Pertaining to the lungs and their air passages; both bronchial and pulmonary. [EU] Bronchopulmonary Dysplasia: A chronic lung disease appearing in certain newborn infants treated for respiratory distress syndrome with mechanical ventilation and elevated concentration of inspired oxygen. [NIH] Bupivacaine: A widely used local anesthetic agent. [NIH] Burns: Injuries to tissues caused by contact with heat, steam, chemicals (burns, chemical), electricity (burns, electric), or the like. [NIH] Burns, Electric: Burns produced by contact with electric current or from a sudden discharge of electricity. [NIH] Bypass: A surgical procedure in which the doctor creates a new pathway for the flow of body fluids. [NIH] Cachexia: General ill health, malnutrition, and weight loss, usually associated with chronic disease. [NIH] Cadaver: A dead body, usually a human body. [NIH] Caffeine: A methylxanthine naturally occurring in some beverages and also used as a pharmacological agent. Caffeine's most notable pharmacological effect is as a central nervous system stimulant, increasing alertness and producing agitation. It also relaxes

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smooth muscle, stimulates cardiac muscle, stimulates diuresis, and appears to be useful in the treatment of some types of headache. Several cellular actions of caffeine have been observed, but it is not entirely clear how each contributes to its pharmacological profile. Among the most important are inhibition of cyclic nucleotide phosphodiesterases, antagonism of adenosine receptors, and modulation of intracellular calcium handling. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Cannula: A tube for insertion into a duct or cavity; during insertion its lumen is usually occupied by a trocar. [EU] Capillary: Any one of the minute vessels that connect the arterioles and venules, forming a network in nearly all parts of the body. Their walls act as semipermeable membranes for the interchange of various substances, including fluids, between the blood and tissue fluid; called also vas capillare. [EU] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. [NIH] Carcinogenic: Producing carcinoma. [EU] Carcinogens: Substances that increase the risk of neoplasms in humans or animals. Both genotoxic chemicals, which affect DNA directly, and nongenotoxic chemicals, which induce neoplasms by other mechanism, are included. [NIH] Cardia: That part of the stomach surrounded by the esophagogastric junction, characterized by the lack of acid-forming cells. [NIH] Cardiac: Having to do with the heart. [NIH] Cardiac Output: The volume of blood passing through the heart per unit of time. It is usually expressed as liters (volume) per minute so as not to be confused with stroke volume (volume per beat). [NIH] Cardiomegaly: Hypertrophy or enlargement of the heart. [NIH] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Carnitine: Constituent of striated muscle and liver. It is used therapeutically to stimulate gastric and pancreatic secretions and in the treatment of hyperlipoproteinemias. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Catheter: A flexible tube used to deliver fluids into or withdraw fluids from the body. [NIH] Catheterization: Use or insertion of a tubular device into a duct, blood vessel, hollow organ, or body cavity for injecting or withdrawing fluids for diagnostic or therapeutic purposes. It differs from intubation in that the tube here is used to restore or maintain patency in obstructions. [NIH]

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Caudal: Denoting a position more toward the cauda, or tail, than some specified point of reference; same as inferior, in human anatomy. [EU] Causal: Pertaining to a cause; directed against a cause. [EU] Cecum: The beginning of the large intestine. The cecum is connected to the lower part of the small intestine, called the ileum. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Death: The termination of the cell's ability to carry out vital functions such as metabolism, growth, reproduction, responsiveness, and adaptability. [NIH] Cell Differentiation: Progressive restriction of the developmental potential and increasing specialization of function which takes place during the development of the embryo and leads to the formation of specialized cells, tissues, and organs. [NIH] Cell Division: The fission of a cell. [NIH] Cell proliferation: An increase in the number of cells as a result of cell growth and cell division. [NIH] Cell Respiration: The metabolic process of all living cells (animal and plant) in which oxygen is used to provide a source of energy for the cell. [NIH] Cell Survival: The span of viability of a cell characterized by the capacity to perform certain functions such as metabolism, growth, reproduction, some form of responsiveness, and adaptability. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Cerebellar: Pertaining to the cerebellum. [EU] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebral Cortex: The thin layer of gray matter on the surface of the cerebral hemisphere that develops from the telencephalon and folds into gyri. It reaches its highest development in man and is responsible for intellectual faculties and higher mental functions. [NIH] Cerebral Palsy: Refers to a motor disability caused by a brain dysfunction. [NIH] Cerebrum: The largest part of the brain. It is divided into two hemispheres, or halves, called the cerebral hemispheres. The cerebrum controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. [NIH] Cervical: Relating to the neck, or to the neck of any organ or structure. Cervical lymph nodes are located in the neck; cervical cancer refers to cancer of the uterine cervix, which is the lower, narrow end (the "neck") of the uterus. [NIH] Cervix: The lower, narrow end of the uterus that forms a canal between the uterus and vagina. [NIH] Character: In current usage, approximately equivalent to personality. The sum of the relatively fixed personality traits and habitual modes of response of an individual. [NIH] Chest cavity: Space in body surrounding the lungs. [NIH] Chest wall: The ribs and muscles, bones, and joints that make up the area of the body between the neck and the abdomen. [NIH] Chin: The anatomical frontal portion of the mandible, also known as the mentum, that contains the line of fusion of the two separate halves of the mandible (symphysis menti). This line of fusion divides inferiorly to enclose a triangular area called the mental protuberance. On each side, inferior to the second premolar tooth, is the mental foramen for

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the passage of blood vessels and a nerve. [NIH] Cholecystectomy: Surgical removal of the gallbladder. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Cholinergic: Resembling acetylcholine in pharmacological action; stimulated by or releasing acetylcholine or a related compound. [EU] Choroid: The thin, highly vascular membrane covering most of the posterior of the eye between the retina and sclera. [NIH] Chromatin: The material of chromosomes. It is a complex of DNA, histones, and nonhistone proteins (chromosomal proteins, non-histone) found within the nucleus of a cell. [NIH] Chromosomal: Pertaining to chromosomes. [EU] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic Disease: Disease or ailment of long duration. [NIH] Chronic renal: Slow and progressive loss of kidney function over several years, often resulting in end-stage renal disease. People with end-stage renal disease need dialysis or transplantation to replace the work of the kidneys. [NIH] Cicatrix: The formation of new tissue in the process of wound healing. [NIH] Cicatrization: The formation of a cicatrix or scar. [EU] Circulatory system: The system that contains the heart and the blood vessels and moves blood throughout the body. This system helps tissues get enough oxygen and nutrients, and it helps them get rid of waste products. The lymph system, which connects with the blood system, is often considered part of the circulatory system. [NIH] Circumcision: Excision of the prepuce or part of it. [NIH] Cirrhosis: A type of chronic, progressive liver disease. [NIH] Clamp: A u-shaped steel rod used with a pin or wire for skeletal traction in the treatment of certain fractures. [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Clone: The term "clone" has acquired a new meaning. It is applied specifically to the bits of inserted foreign DNA in the hybrid molecules of the population. Each inserted segment originally resided in the DNA of a complex genome amid millions of other DNA segment. [NIH]

Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Coca: Any of several South American shrubs of the Erythroxylon genus (and family) that yield cocaine; the leaves are chewed with alum for CNS stimulation. [NIH] Cocaine: An alkaloid ester extracted from the leaves of plants including coca. It is a local anesthetic and vasoconstrictor and is clinically used for that purpose, particularly in the eye, ear, nose, and throat. It also has powerful central nervous system effects similar to the amphetamines and is a drug of abuse. Cocaine, like amphetamines, acts by multiple mechanisms on brain catecholaminergic neurons; the mechanism of its reinforcing effects is thought to involve inhibition of dopamine uptake. [NIH] Coenzyme: An organic nonprotein molecule, frequently a phosphorylated derivative of a

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water-soluble vitamin, that binds with the protein molecule (apoenzyme) to form the active enzyme (holoenzyme). [EU] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Collapse: 1. A state of extreme prostration and depression, with failure of circulation. 2. Abnormal falling in of the walls of any part of organ. [EU] Colon: The long, coiled, tubelike organ that removes water from digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus. [NIH] Colostomy: An opening into the colon from the outside of the body. A colostomy provides a new path for waste material to leave the body after part of the colon has been removed. [NIH] Comorbidity: The presence of co-existing or additional diseases with reference to an initial diagnosis or with reference to the index condition that is the subject of study. Comorbidity may affect the ability of affected individuals to function and also their survival; it may be used as a prognostic indicator for length of hospital stay, cost factors, and outcome or survival. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy,

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spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementation: The production of a wild-type phenotype when two different mutations are combined in a diploid or a heterokaryon and tested in trans-configuration. [NIH] Compliance: Distensibility measure of a chamber such as the lungs (lung compliance) or bladder. Compliance is expressed as a change in volume per unit change in pressure. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Computed tomography: CT scan. A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized tomography and computerized axial tomography (CAT) scan. [NIH] Computerized tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized axial tomography (CAT) scan and computed tomography (CT scan). [NIH] Conception: The onset of pregnancy, marked by implantation of the blastocyst; the formation of a viable zygote. [EU] Concomitant: Accompanying; accessory; joined with another. [EU] Conduction: The transfer of sound waves, heat, nervous impulses, or electricity. [EU] Cone: One of the special retinal receptor elements which are presumed to be primarily concerned with perception of light and color stimuli when the eye is adapted to light. [NIH] Conjunctiva: The mucous membrane that lines the inner surface of the eyelids and the anterior part of the sclera. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue Cells: A group of cells that includes fibroblasts, cartilage cells, adipocytes, smooth muscle cells, and bone cells. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Constipation: Infrequent or difficult evacuation of feces. [NIH] Constitutional: 1. Affecting the whole constitution of the body; not local. 2. Pertaining to the constitution. [EU] Constriction: The act of constricting. [NIH] Constriction, Pathologic: The condition of an anatomical structure's being constricted beyond normal dimensions. [NIH] Consumption: Pulmonary tuberculosis. [NIH]

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Contamination: The soiling or pollution by inferior material, as by the introduction of organisms into a wound, or sewage into a stream. [EU] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Contralateral: Having to do with the opposite side of the body. [NIH] Control group: In a clinical trial, the group that does not receive the new treatment being studied. This group is compared to the group that receives the new treatment, to see if the new treatment works. [NIH] Controlled study: An experiment or clinical trial that includes a comparison (control) group. [NIH]

Conus: A large, circular, white patch around the optic disk due to the exposing of the sclera as a result of degenerative change or congenital abnormality in the choroid and retina. [NIH] Convalescence: The period of recovery following an illness. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary Circulation: The circulation of blood through the coronary vessels of the heart. [NIH]

Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Corpus: The body of the uterus. [NIH] Corpus Callosum: Broad plate of dense myelinated fibers that reciprocally interconnect regions of the cortex in all lobes with corresponding regions of the opposite hemisphere. The corpus callosum is located deep in the longitudinal fissure. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Corticosteroids: Hormones that have antitumor activity in lymphomas and lymphoid leukemias; in addition, corticosteroids (steroids) may be used for hormone replacement and for the management of some of the complications of cancer and its treatment. [NIH] Cortisone: A natural steroid hormone produced in the adrenal gland. It can also be made in the laboratory. Cortisone reduces swelling and can suppress immune responses. [NIH] Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU] Cryptorchidism: A condition in which one or both testicles fail to move from the abdomen, where they develop before birth, into the scrotum. Cryptorchidism may increase the risk for development of testicular cancer. Also called undescended testicles. [NIH] Cues: Signals for an action; that specific portion of a perceptual field or pattern of stimuli to which a subject has learned to respond. [NIH] Culture Media: Any liquid or solid preparation made specifically for the growth, storage, or transport of microorganisms or other types of cells. The variety of media that exist allow for the culturing of specific microorganisms and cell types, such as differential media, selective media, test media, and defined media. Solid media consist of liquid media that have been solidified with an agent such as agar or gelatin. [NIH] Curare: Plant extracts from several species, including Strychnos toxifera, S. castelnaei, S. crevauxii, and Chondodendron tomentosum, that produce paralysis of skeletal muscle and are used adjunctively with general anesthesia. These extracts are toxic and must be used

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with the administration of artificial respiration. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Cutaneous: Having to do with the skin. [NIH] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Cyst: A sac or capsule filled with fluid. [NIH] Cystostomy: Surgical creation of an opening (stoma) for drainage of the urinary bladder. [NIH]

Cytokines: Non-antibody proteins secreted by inflammatory leukocytes and some nonleukocytic cells, that act as intercellular mediators. They differ from classical hormones in that they are produced by a number of tissue or cell types rather than by specialized glands. They generally act locally in a paracrine or autocrine rather than endocrine manner. [NIH] Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Cytoskeleton: The network of filaments, tubules, and interconnecting filamentous bridges which give shape, structure, and organization to the cytoplasm. [NIH] Cytotoxic: Cell-killing. [NIH] De novo: In cancer, the first occurrence of cancer in the body. [NIH] Decompression: Decompression external to the body, most often the slow lessening of external pressure on the whole body (especially in caisson workers, deep sea divers, and persons who ascend to great heights) to prevent decompression sickness. It includes also sudden accidental decompression, but not surgical (local) decompression or decompression applied through body openings. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Deletion: A genetic rearrangement through loss of segments of DNA (chromosomes), bringing sequences, which are normally separated, into close proximity. [NIH] Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. [NIH] Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Depolarization: The process or act of neutralizing polarity. In neurophysiology, the reversal of the resting potential in excitable cell membranes when stimulated, i.e., the tendency of the cell membrane potential to become positive with respect to the potential outside the cell. [EU] Deuterium: Deuterium. The stable isotope of hydrogen. It has one neutron and one proton in the nucleus. [NIH] Dexamethasone: (11 beta,16 alpha)-9-Fluoro-11,17,21-trihydroxy-16-methylpregna-1,4diene-3,20-dione. An anti-inflammatory glucocorticoid used either in the free alcohol or esterified form in treatment of conditions that respond generally to cortisone. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diaphragm: The musculofibrous partition that separates the thoracic cavity from the abdominal cavity. Contraction of the diaphragm increases the volume of the thoracic cavity

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aiding inspiration. [NIH] Diastolic: Of or pertaining to the diastole. [EU] Diclofenac: A non-steroidal anti-inflammatory agent (NSAID) with antipyretic and analgesic actions. It is primarily available as the sodium salt, diclofenac sodium. [NIH] Diclofenac Sodium: The sodium form of diclofenac. It is used for its analgesic and antiinflammatory properties. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive system: The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum. [NIH] Digestive tract: The organs through which food passes when food is eaten. These organs are the mouth, esophagus, stomach, small and large intestines, and rectum. [NIH] Dilatation: The act of dilating. [NIH] Dilation: A process by which the pupil is temporarily enlarged with special eye drops (mydriatic); allows the eye care specialist to better view the inside of the eye. [NIH] Diploid: Having two sets of chromosomes. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Discrete: Made up of separate parts or characterized by lesions which do not become blended; not running together; separate. [NIH] Disease Progression: The worsening of a disease over time. This concept is most often used for chronic and incurable diseases where the stage of the disease is an important determinant of therapy and prognosis. [NIH] Disposition: A tendency either physical or mental toward certain diseases. [EU] Dissection: Cutting up of an organism for study. [NIH] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Distention: The state of being distended or enlarged; the act of distending. [EU] Diuresis: Increased excretion of urine. [EU] Diverticula: Plural form of diverticulum. [NIH] Diverticulitis: Inflammation of a diverticulum or diverticula. [NIH] Diverticulum: A pathological condition manifested as a pouch or sac opening from a tubular or sacular organ. [NIH] Dopamine: An endogenous catecholamine and prominent neurotransmitter in several systems of the brain. In the synthesis of catecholamines from tyrosine, it is the immediate precursor to norepinephrine and epinephrine. Dopamine is a major transmitter in the extrapyramidal system of the brain, and important in regulating movement. A family of dopaminergic receptor subtypes mediate its action. Dopamine is used pharmacologically for its direct (beta adrenergic agonist) and indirect (adrenergic releasing) sympathomimetic effects including its actions as an inotropic agent and as a renal vasodilator. [NIH] Dorsal: 1. Pertaining to the back or to any dorsum. 2. Denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU]

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Double-blind: Pertaining to a clinical trial or other experiment in which neither the subject nor the person administering treatment knows which treatment any particular subject is receiving. [EU] Drive: A state of internal activity of an organism that is a necessary condition before a given stimulus will elicit a class of responses; e.g., a certain level of hunger (drive) must be present before food will elicit an eating response. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Duct: A tube through which body fluids pass. [NIH] Ductus Arteriosus: A fetal blood vessel connecting the pulmonary artery with the descending aorta. [NIH] Duodenal Ulcer: An ulcer in the lining of the first part of the small intestine (duodenum). [NIH]

Duodenum: The first part of the small intestine. [NIH] Dura mater: The outermost, toughest, and most fibrous of the three membranes (meninges) covering the brain and spinal cord; called also pachymeninx. [EU] Dysostosis: Defective bone formation. [NIH] Dyspepsia: Impaired digestion, especially after eating. [NIH] Dysphagia: Difficulty in swallowing. [EU] Dysplasia: Cells that look abnormal under a microscope but are not cancer. [NIH] Dyspnea: Difficult or labored breathing. [NIH] Dystrophy: Any disorder arising from defective or faulty nutrition, especially the muscular dystrophies. [EU] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Ejaculation: The release of semen through the penis during orgasm. [NIH] Elastic: Susceptible of resisting and recovering from stretching, compression or distortion applied by a force. [EU] Elastin: The protein that gives flexibility to tissues. [NIH] Elective: Subject to the choice or decision of the patient or physician; applied to procedures that are advantageous to the patient but not urgent. [EU] Embolus: Bit of foreign matter which enters the blood stream at one point and is carried until it is lodged or impacted in an artery and obstructs it. It may be a blood clot, an air bubble, fat or other tissue, or clumps of bacteria. [NIH] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Embryology: The study of the development of an organism during the embryonic and fetal stages of life. [NIH] Emollient: Softening or soothing; called also malactic. [EU] Emphysema: A pathological accumulation of air in tissues or organs. [NIH] Empyema: Presence of pus in a hollow organ or body cavity. [NIH] Emulsion: A preparation of one liquid distributed in small globules throughout the body of a second liquid. The dispersed liquid is the discontinuous phase, and the dispersion

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medium is the continuous phase. When oil is the dispersed liquid and an aqueous solution is the continuous phase, it is known as an oil-in-water emulsion, whereas when water or aqueous solution is the dispersed phase and oil or oleaginous substance is the continuous phase, it is known as a water-in-oil emulsion. Pharmaceutical emulsions for which official standards have been promulgated include cod liver oil emulsion, cod liver oil emulsion with malt, liquid petrolatum emulsion, and phenolphthalein in liquid petrolatum emulsion. [EU] Endogenous: Produced inside an organism or cell. The opposite is external (exogenous) production. [NIH] Endometrial: Having to do with the endometrium (the layer of tissue that lines the uterus). [NIH]

Endometriosis: A condition in which tissue more or less perfectly resembling the uterine mucous membrane (the endometrium) and containing typical endometrial granular and stromal elements occurs aberrantly in various locations in the pelvic cavity. [NIH] Endometrium: The layer of tissue that lines the uterus. [NIH] Endoscope: A thin, lighted tube used to look at tissues inside the body. [NIH] Endoscopic: A technique where a lateral-view endoscope is passed orally to the duodenum for visualization of the ampulla of Vater. [NIH] Endoscopy: Endoscopic examination, therapy or surgery performed on interior parts of the body. [NIH] Endothelial cell: The main type of cell found in the inside lining of blood vessels, lymph vessels, and the heart. [NIH] Endothelium: A layer of epithelium that lines the heart, blood vessels (endothelium, vascular), lymph vessels (endothelium, lymphatic), and the serous cavities of the body. [NIH] Endothelium-derived: Small molecule that diffuses to the adjacent muscle layer and relaxes it. [NIH] Endotoxin: Toxin from cell walls of bacteria. [NIH] End-stage renal: Total chronic kidney failure. When the kidneys fail, the body retains fluid and harmful wastes build up. A person with ESRD needs treatment to replace the work of the failed kidneys. [NIH] Environmental Exposure: The exposure to potentially harmful chemical, physical, or biological agents in the environment or to environmental factors that may include ionizing radiation, pathogenic organisms, or toxic chemicals. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Epidural: The space between the wall of the spinal canal and the covering of the spinal cord. An epidural injection is given into this space. [NIH] Epigastric: Having to do with the upper middle area of the abdomen. [NIH] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH]

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Epithelial Cells: Cells that line the inner and outer surfaces of the body. [NIH] Epithelium: One or more layers of epithelial cells, supported by the basal lamina, which covers the inner or outer surfaces of the body. [NIH] Equipment and Supplies: Expendable and nonexpendable equipment, supplies, apparatus, and instruments that are used in diagnostic, surgical, therapeutic, scientific, and experimental procedures. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Esophageal: Having to do with the esophagus, the muscular tube through which food passes from the throat to the stomach. [NIH] Esophageal Manometry: A test to measure muscle tone inthe esophagus. [NIH] Esophageal Perforation: A dilated vessel in the lower end of the esophagus that result from portal hypertension. [NIH] Esophagectomy: An operation to remove a portion of the esophagus. [NIH] Esophagitis: Inflammation, acute or chronic, of the esophagus caused by bacteria, chemicals, or trauma. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Essential Tremor: A rhythmic, involuntary, purposeless, oscillating movement resulting from the alternate contraction and relaxation of opposing groups of muscles. [NIH] Estrogens: A class of sex hormones associated with the development and maintenance of secondary female sex characteristics and control of the cyclical changes in the reproductive cycle. They are also required for pregnancy maintenance and have an anabolic effect on protein metabolism and water retention. [NIH] Ether: One of a class of organic compounds in which any two organic radicals are attached directly to a single oxygen atom. [NIH] Ethnic Groups: A group of people with a common cultural heritage that sets them apart from others in a variety of social relationships. [NIH] Eukaryotic Cells: Cells of the higher organisms, containing a true nucleus bounded by a nuclear membrane. [NIH] Evacuation: An emptying, as of the bowels. [EU] Evoke: The electric response recorded from the cerebral cortex after stimulation of a peripheral sense organ. [NIH] Exocrine: Secreting outwardly, via a duct. [EU] Expiration: The act of breathing out, or expelling air from the lungs. [EU] Expiratory: The volume of air which leaves the breathing organs in each expiration. [NIH] Expiratory Reserve Volume: The extra volume of air that can be expired with maximum effort beyond the level reached at the end of a normal, quiet expiration. Common abbreviation is ERV. [NIH] Extracellular: Outside a cell or cells. [EU] Extracellular Matrix: A meshwork-like substance found within the extracellular space and in association with the basement membrane of the cell surface. It promotes cellular proliferation and provides a supporting structure to which cells or cell lysates in culture dishes adhere. [NIH]

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Extracellular Matrix Proteins: Macromolecular organic compounds that contain carbon, hydrogen, oxygen, nitrogen, and usually, sulfur. These macromolecules (proteins) form an intricate meshwork in which cells are embedded to construct tissues. Variations in the relative types of macromolecules and their organization determine the type of extracellular matrix, each adapted to the functional requirements of the tissue. The two main classes of macromolecules that form the extracellular matrix are: glycosaminoglycans, usually linked to proteins (proteoglycans), and fibrous proteins (e.g., collagen, elastin, fibronectins and laminin). [NIH] Extracellular Space: Interstitial space between cells, occupied by fluid as well as amorphous and fibrous substances. [NIH] Extracorporeal: Situated or occurring outside the body. [EU] Extracorporeal Membrane Oxygenation: Application of a life support system that circulates the blood through an oxygenating system, which may consist of a pump, a membrane oxygenator, and a heat exchanger. Examples of its use are to assist victims of smoke inhalation injury, respiratory failure, and cardiac failure. [NIH] Extravasation: A discharge or escape, as of blood, from a vessel into the tissues. [EU] Extremity: A limb; an arm or leg (membrum); sometimes applied specifically to a hand or foot. [EU] Faecal: Pertaining to or of the nature of feces. [EU] Fallopian tube: The oviduct, a muscular tube about 10 cm long, lying in the upper border of the broad ligament. [NIH] Falx: Name applied to any structure comparable to a sickle in shape. [NIH] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatty acids: A major component of fats that are used by the body for energy and tissue development. [NIH] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Femoral: Pertaining to the femur, or to the thigh. [EU] Femur: The longest and largest bone of the skeleton, it is situated between the hip and the knee. [NIH] Fetal Blood: Blood of the fetus. Exchange of nutrients and waste between the fetal and maternal blood occurs via the placenta. The cord blood is blood contained in the umbilical vessels at the time of delivery. [NIH] Fetal Monitoring: Physiologic or biochemical monitoring of the fetus. It is usually done during labor and may be performed in conjunction with the monitoring of uterine activity. It may also be performed prenatally as when the mother is undergoing surgery. [NIH] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibrin: A protein derived from fibrinogen in the presence of thrombin, which forms part of the blood clot. [NIH] Fibrinogen: Plasma glycoprotein clotted by thrombin, composed of a dimer of three nonidentical pairs of polypeptide chains (alpha, beta, gamma) held together by disulfide bonds. Fibrinogen clotting is a sol-gel change involving complex molecular arrangements: whereas fibrinogen is cleaved by thrombin to form polypeptides A and B, the proteolytic action of other enzymes yields different fibrinogen degradation products. [NIH]

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Fibroblasts: Connective tissue cells which secrete an extracellular matrix rich in collagen and other macromolecules. [NIH] Fibronectins: Glycoproteins found on the surfaces of cells, particularly in fibrillar structures. The proteins are lost or reduced when these cells undergo viral or chemical transformation. They are highly susceptible to proteolysis and are substrates for activated blood coagulation factor VIII. The forms present in plasma are called cold-insoluble globulins. [NIH] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] Fissure: Any cleft or groove, normal or otherwise; especially a deep fold in the cerebral cortex which involves the entire thickness of the brain wall. [EU] Fistula: Abnormal communication most commonly seen between two internal organs, or between an internal organ and the surface of the body. [NIH] Fixation: 1. The act or operation of holding, suturing, or fastening in a fixed position. 2. The condition of being held in a fixed position. 3. In psychiatry, a term with two related but distinct meanings : (1) arrest of development at a particular stage, which like regression (return to an earlier stage), if temporary is a normal reaction to setbacks and difficulties but if protracted or frequent is a cause of developmental failures and emotional problems, and (2) a close and suffocating attachment to another person, especially a childhood figure, such as one's mother or father. Both meanings are derived from psychoanalytic theory and refer to 'fixation' of libidinal energy either in a specific erogenous zone, hence fixation at the oral, anal, or phallic stage, or in a specific object, hence mother or father fixation. 4. The use of a fixative (q.v.) to preserve histological or cytological specimens. 5. In chemistry, the process whereby a substance is removed from the gaseous or solution phase and localized, as in carbon dioxide fixation or nitrogen fixation. 6. In ophthalmology, direction of the gaze so that the visual image of the object falls on the fovea centralis. 7. In film processing, the chemical removal of all undeveloped salts of the film emulsion, leaving only the developed silver to form a permanent image. [EU] Flatulence: Production or presence of gas in the gastrointestinal tract which may be expelled through the anus. [NIH] Flatus: Gas passed through the rectum. [NIH] Fluoroscopy: Production of an image when X-rays strike a fluorescent screen. [NIH] Fold: A plication or doubling of various parts of the body. [NIH] Foramen: A natural hole of perforation, especially one in a bone. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Fossa: A cavity, depression, or pit. [NIH] Fovea: The central part of the macula that provides the sharpest vision. [NIH] Free Radicals: Highly reactive molecules with an unsatisfied electron valence pair. Free radicals are produced in both normal and pathological processes. They are proven or suspected agents of tissue damage in a wide variety of circumstances including radiation, damage from environment chemicals, and aging. Natural and pharmacological prevention of free radical damage is being actively investigated. [NIH] Functional Residual Capacity: The volume of air remaining in the lungs at the end of a normal, quiet expiration. It is the sum of the residual volume and the expiratory reserve volume. Common abbreviation is FRC. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH]

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Gamma irradiation: A type of radiation therapy that uses gamma radiation. Gamma radiation is a type of high-energy radiation that is different from x-rays. [NIH] Ganglion: 1. A knot, or knotlike mass. 2. A general term for a group of nerve cell bodies located outside the central nervous system; occasionally applied to certain nuclear groups within the brain or spinal cord, e.g. basal ganglia. 3. A benign cystic tumour occurring on a aponeurosis or tendon, as in the wrist or dorsum of the foot; it consists of a thin fibrous capsule enclosing a clear mucinous fluid. [EU] Gangrene: Death and putrefaction of tissue usually due to a loss of blood supply. [NIH] Gangrenous: A circumscribed, deep-seated, suppurative inflammation of the subcutaneous tissue of the eyelid discharging pus from several points. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gas exchange: Primary function of the lungs; transfer of oxygen from inhaled air into the blood and of carbon dioxide from the blood into the lungs. [NIH] Gas Gangrene: A severe condition resulting from bacteria invading healthy muscle from adjacent traumatized muscle or soft tissue. The infection originates in a wound contaminated with bacteria of the genus Clostridium. C. perfringens accounts for the majority of cases (over eighty percent), while C. noyvi, C. septicum, and C. histolyticum cause most of the other cases. [NIH] Gastrectomy: An operation to remove all or part of the stomach. [NIH] Gastric: Having to do with the stomach. [NIH] Gastric Juices: Liquids produced in the stomach to help break down food and kill bacteria. [NIH]

Gastric Mucosa: Surface epithelium in the stomach that invaginates into the lamina propria, forming gastric pits. Tubular glands, characteristic of each region of the stomach (cardiac, gastric, and pyloric), empty into the gastric pits. The gastric mucosa is made up of several different kinds of cells. [NIH] Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]

Gastritis: Inflammation of the stomach. [EU] Gastroenterologist: A doctor who specializes in diagnosing and treating disorders of the digestive system. [NIH] Gastroenterology: A subspecialty of internal medicine concerned with the study of the physiology and diseases of the digestive system and related structures (esophagus, liver, gallbladder, and pancreas). [NIH] Gastroesophageal Reflux: Reflux of gastric juice and/or duodenal contents (bile acids, pancreatic juice) into the distal esophagus, commonly due to incompetence of the lower esophageal sphincter. Gastric regurgitation is an extension of this process with entry of fluid into the pharynx or mouth. [NIH] Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal stromal tumor: GIST. A type of tumor that usually begins in cells in the wall of the gastrointestinal tract. It can be benign or malignant. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gastroscopy: Endoscopic examination, therapy, or surgery of the interior of the stomach. [NIH]

Gelatin: A product formed from skin, white connective tissue, or bone collagen. It is used as

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a protein food adjuvant, plasma substitute, hemostatic, suspending agent in pharmaceutical preparations, and in the manufacturing of capsules and suppositories. [NIH] Gels: Colloids with a solid continuous phase and liquid as the dispersed phase; gels may be unstable when, due to temperature or other cause, the solid phase liquifies; the resulting colloid is called a sol. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Gene Expression: The phenotypic manifestation of a gene or genes by the processes of gene action. [NIH] Gene Therapy: The introduction of new genes into cells for the purpose of treating disease by restoring or adding gene expression. Techniques include insertion of retroviral vectors, transfection, homologous recombination, and injection of new genes into the nuclei of single cell embryos. The entire gene therapy process may consist of multiple steps. The new genes may be introduced into proliferating cells in vivo (e.g., bone marrow) or in vitro (e.g., fibroblast cultures) and the modified cells transferred to the site where the gene expression is required. Gene therapy may be particularly useful for treating enzyme deficiency diseases, hemoglobinopathies, and leukemias and may also prove useful in restoring drug sensitivity, particularly for leukemia. [NIH] Genital: Pertaining to the genitalia. [EU] Genitourinary: Pertaining to the genital and urinary organs; urogenital; urinosexual. [EU] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Germ Cells: The reproductive cells in multicellular organisms. [NIH] Gestation: The period of development of the young in viviparous animals, from the time of fertilization of the ovum until birth. [EU] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glucocorticoid: A compound that belongs to the family of compounds called corticosteroids (steroids). Glucocorticoids affect metabolism and have anti-inflammatory and immunosuppressive effects. They may be naturally produced (hormones) or synthetic (drugs). [NIH] Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glucuronic Acid: Derivatives of uronic acid found throughout the plant and animal kingdoms. They detoxify drugs and toxins by conjugating with them to form glucuronides in the liver which are more water-soluble metabolites that can be easily eliminated from the body. [NIH] Glycerol: A trihydroxy sugar alcohol that is an intermediate in carbohydrate and lipid metabolism. It is used as a solvent, emollient, pharmaceutical agent, and sweetening agent. [NIH]

Glycoprotein: A protein that has sugar molecules attached to it. [NIH] Glycosaminoglycans: Heteropolysaccharides which contain an N-acetylated hexosamine in a characteristic repeating disaccharide unit. The repeating structure of each disaccharide involves alternate 1,4- and 1,3-linkages consisting of either N-acetylglucosamine or Nacetylgalactosamine. [NIH]

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Gonad: A sex organ, such as an ovary or a testicle, which produces the gametes in most multicellular animals. [NIH] Gonadal: Pertaining to a gonad. [EU] Gonadotropin: The water-soluble follicle stimulating substance, by some believed to originate in chorionic tissue, obtained from the serum of pregnant mares. It is used to supplement the action of estrogens. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Grade: The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer. [NIH] Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH] Graft Rejection: An immune response with both cellular and humoral components, directed against an allogeneic transplant, whose tissue antigens are not compatible with those of the recipient. [NIH] Grafting: The operation of transfer of tissue from one site to another. [NIH] Gram-positive: Retaining the stain or resisting decolorization by alcohol in Gram's method of staining, a primary characteristic of bacteria whose cell wall is composed of a thick layer of peptidologlycan with attached teichoic acids. [EU] Granulocytes: Leukocytes with abundant granules in the cytoplasm. They are divided into three groups: neutrophils, eosinophils, and basophils. [NIH] Granuloma: A relatively small nodular inflammatory lesion containing grouped mononuclear phagocytes, caused by infectious and noninfectious agents. [NIH] Groin: The external junctural region between the lower part of the abdomen and the thigh. [NIH]

Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Growth factors: Substances made by the body that function to regulate cell division and cell survival. Some growth factors are also produced in the laboratory and used in biological therapy. [NIH] Guanylate Cyclase: An enzyme that catalyzes the conversion of GTP to 3',5'-cyclic GMP and pyrophosphate. It also acts on ITP and dGTP. (From Enzyme Nomenclature, 1992) EC 4.6.1.2. [NIH] Haematoma: A localized collection of blood, usually clotted, in an organ, space, or tissue, due to a break in the wall of a blood vessel. [EU] Haemorrhage: The escape of blood from the vessels; bleeding. Small haemorrhages are classified according to size as petechiae (very small), purpura (up to 1 cm), and ecchymoses (larger). The massive accumulation of blood within a tissue is called a haematoma. [EU] Headache: Pain in the cranial region that may occur as an isolated and benign symptom or as a manifestation of a wide variety of conditions including subarachnoid hemorrhage; craniocerebral trauma; central nervous system infections; intracranial hypertension; and other disorders. In general, recurrent headaches that are not associated with a primary disease process are referred to as headache disorders (e.g., migraine). [NIH] Heart Transplantation: The transference of a heart from one human or animal to another. [NIH]

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Heartburn: Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus. [NIH] Hematoma: An extravasation of blood localized in an organ, space, or tissue. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hemoglobinopathies: A group of inherited disorders characterized by structural alterations within the hemoglobin molecule. [NIH] Hemoglobinuria: The presence of free hemoglobin in the urine. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemostasis: The process which spontaneously arrests the flow of blood from vessels carrying blood under pressure. It is accomplished by contraction of the vessels, adhesion and aggregation of formed blood elements, and the process of blood or plasma coagulation. [NIH]

Heparin: Heparinic acid. A highly acidic mucopolysaccharide formed of equal parts of sulfated D-glucosamine and D-glucuronic acid with sulfaminic bridges. The molecular weight ranges from six to twenty thousand. Heparin occurs in and is obtained from liver, lung, mast cells, etc., of vertebrates. Its function is unknown, but it is used to prevent blood clotting in vivo and vitro, in the form of many different salts. [NIH] Hepatic: Refers to the liver. [NIH] Hepatitis: Inflammation of the liver and liver disease involving degenerative or necrotic alterations of hepatocytes. [NIH] Hepatocytes: The main structural component of the liver. They are specialized epithelial cells that are organized into interconnected plates called lobules. [NIH] Herbicide: A chemical that kills plants. [NIH] Hereditary: Of, relating to, or denoting factors that can be transmitted genetically from one generation to another. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Hernia: Protrusion of a loop or knuckle of an organ or tissue through an abnormal opening. [NIH]

Hernia, Hiatal: Herniation of the lower esophagus and/or portion of the stomach through the esophageal hiatus. [NIH] Herniated: Protrusion of a degenerated or fragmented intervertebral disc into the intervertebral foramen compressing the nerve root. [NIH] Herniorrhaphy: An operation to repair a hernia. [NIH] Hiatal Hernia: A small opening in the diaphragm that allows the upper part of the stomach to move up into the chest. Causes heartburn from stomach acid flowing back up through the opening. [NIH] Histamine: 1H-Imidazole-4-ethanamine. A depressor amine derived by enzymatic

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decarboxylation of histidine. It is a powerful stimulant of gastric secretion, a constrictor of bronchial smooth muscle, a vasodilator, and also a centrally acting neurotransmitter. [NIH] Histamine Release: The secretion of histamine from mast cell and basophil granules by exocytosis. This can be initiated by a number of factors, all of which involve binding of IgE, cross-linked by antigen, to the mast cell or basophil's Fc receptors. Once released, histamine binds to a number of different target cell receptors and exerts a wide variety of effects. [NIH] Histology: The study of tissues and cells under a microscope. [NIH] Hoarseness: An unnaturally deep or rough quality of voice. [NIH] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormonal therapy: Treatment of cancer by removing, blocking, or adding hormones. Also called hormone therapy or endocrine therapy. [NIH] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hormone therapy: Treatment of cancer by removing, blocking, or adding hormones. Also called endocrine therapy. [NIH] Host: Any animal that receives a transplanted graft. [NIH] Humoral: Of, relating to, proceeding from, or involving a bodily humour - now often used of endocrine factors as opposed to neural or somatic. [EU] Hyaline membrane disease: A respiratory disease of newborns, especially premature infants, in which a membrane composed of proteins and dead cells forms and lines the alveoli making gas exchange difficult or impossible. [NIH] Hybrid: Cross fertilization between two varieties or, more usually, two species of vines, see also crossing. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrolysis: The process of cleaving a chemical compound by the addition of a molecule of water. [NIH] Hydroxylysine: A hydroxylated derivative of the amino acid lysine that is present in certain collagens. [NIH] Hydroxyproline: A hydroxylated form of the imino acid proline. A deficiency in ascorbic acid can result in impaired hydroxyproline formation. [NIH] Hyperbilirubinemia: Pathologic process consisting of an abnormal increase in the amount of bilirubin in the circulating blood, which may result in jaundice. [NIH] Hyperplasia: An increase in the number of cells in a tissue or organ, not due to tumor formation. It differs from hypertrophy, which is an increase in bulk without an increase in the number of cells. [NIH] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels

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are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hypertrophy: General increase in bulk of a part or organ, not due to tumor formation, nor to an increase in the number of cells. [NIH] Hypoplasia: Incomplete development or underdevelopment of an organ or tissue. [EU] Hypotensive: Characterized by or causing diminished tension or pressure, as abnormally low blood pressure. [EU] Hysterectomy: Excision of the uterus. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Ileostomy: Surgical creation of an external opening into the ileum for fecal diversion or drainage. Loop or tube procedures are most often employed. [NIH] Ileum: The lower end of the small intestine. [NIH] Immaturity: The state or quality of being unripe or not fully developed. [EU] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

Immunodeficiency: The decreased ability of the body to fight infection and disease. [NIH] Immunodiffusion: Technique involving the diffusion of antigen or antibody through a semisolid medium, usually agar or agarose gel, with the result being a precipitin reaction. [NIH]

Immunoelectrophoresis: A technique that combines protein electrophoresis and double immunodiffusion. In this procedure proteins are first separated by gel electrophoresis (usually agarose), then made visible by immunodiffusion of specific antibodies. A distinct elliptical precipitin arc results for each protein detectable by the antisera. [NIH] Immunosuppressive: Describes the ability to lower immune system responses. [NIH] Impaction: The trapping of an object in a body passage. Examples are stones in the bile duct or hardened stool in the colon. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Implantation: The insertion or grafting into the body of biological, living, inert, or radioactive material. [EU] In situ: In the natural or normal place; confined to the site of origin without invasion of neighbouring tissues. [EU] In Situ Hybridization: A technique that localizes specific nucleic acid sequences within intact chromosomes, eukaryotic cells, or bacterial cells through the use of specific nucleic acid-labeled probes. [NIH] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incision: A cut made in the body during surgery. [NIH] Incisional: The removal of a sample of tissue for examination under a microscope. [NIH] Incompetence: Physical or mental inadequacy or insufficiency. [EU] Incontinence: Inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the rectum (fecal incontinence). [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Indigestion: Poor digestion. Symptoms include heartburn, nausea, bloating, and gas. Also

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called dyspepsia. [NIH] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Infertility: The diminished or absent ability to conceive or produce an offspring while sterility is the complete inability to conceive or produce an offspring. [NIH] Infiltration: The diffusion or accumulation in a tissue or cells of substances not normal to it or in amounts of the normal. Also, the material so accumulated. [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Inguinal: Pertaining to the inguen, or groin. [EU] Inguinal Hernia: A small part of the large or small intestine or bladder that pushes into the groin. May cause pain and feelings of pressure or burning in the groin. Often requires surgery. [NIH] Initiation: Mutation induced by a chemical reactive substance causing cell changes; being a step in a carcinogenic process. [NIH] Inlay: In dentistry, a filling first made to correspond with the form of a dental cavity and then cemented into the cavity. [NIH] Insufflation: The act of blowing a powder, vapor, or gas into any body cavity for experimental, diagnostic, or therapeutic purposes. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Insulin-dependent diabetes mellitus: A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes. [NIH] Insulin-like: Muscular growth factor. [NIH] Intercostal: Situated between the ribs. [EU] Internal Medicine: A medical specialty concerned with the diagnosis and treatment of diseases of the internal organ systems of adults. [NIH] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intervertebral: Situated between two contiguous vertebrae. [EU] Intervertebral Disk Displacement: An intervertebral disk in which the nucleus pulposus has protruded through surrounding fibrocartilage. This occurs most frequently in the lower lumbar region. [NIH] Intestinal: Having to do with the intestines. [NIH]

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Intestinal Obstruction: Any impairment, arrest, or reversal of the normal flow of intestinal contents toward the anus. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intracellular: Inside a cell. [NIH] Intramuscular: IM. Within or into muscle. [NIH] Intraperitoneal: IP. Within the peritoneal cavity (the area that contains the abdominal organs). [NIH] Intravenous: IV. Into a vein. [NIH] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Intubation: Introduction of a tube into a hollow organ to restore or maintain patency if obstructed. It is differentiated from catheterization in that the insertion of a catheter is usually performed for the introducing or withdrawing of fluids from the body. [NIH] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]

Involuntary: Reaction occurring without intention or volition. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Irradiation: The use of high-energy radiation from x-rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy) or from materials called radioisotopes. Radioisotopes produce radiation and can be placed in or near the tumor or in the area near cancer cells. This type of radiation treatment is called internal radiation therapy, implant radiation, interstitial radiation, or brachytherapy. Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Irradiation is also called radiation therapy, radiotherapy, and x-ray therapy. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Jaundice: A clinical manifestation of hyperbilirubinemia, consisting of deposition of bile pigments in the skin, resulting in a yellowish staining of the skin and mucous membranes. [NIH]

Joint: The point of contact between elements of an animal skeleton with the parts that surround and support it. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Ketorolac: A drug that belongs to a family of drugs called nonsteroidal anti-inflammatory agents. It is being studied in cancer prevention. [NIH] Keyhole: A carrier molecule. [NIH] Kidney Disease: Any one of several chronic conditions that are caused by damage to the cells of the kidney. People who have had diabetes for a long time may have kidney damage. Also called nephropathy. [NIH] Kidney Pelvis: The flattened, funnel-shaped expansion connecting the ureter to the kidney calices. [NIH] Kinetic: Pertaining to or producing motion. [EU]

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Lacrimal: Pertaining to the tears. [EU] Lacrimal gland: The small almond-shaped structure that produces tears; located just above the outer corner of the eye. [NIH] Laminin: Large, noncollagenous glycoprotein with antigenic properties. It is localized in the basement membrane lamina lucida and functions to bind epithelial cells to the basement membrane. Evidence suggests that the protein plays a role in tumor invasion. [NIH] Laparoscopy: Examination, therapy or surgery of the abdomen's interior by means of a laparoscope. [NIH] Laparotomy: A surgical incision made in the wall of the abdomen. [NIH] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Laryngitis: Inflammation of the larynx. This condition presents itself with dryness and soreness of the throat, difficulty in swallowing, cough, and hoarseness. [NIH] Larynx: An irregularly shaped, musculocartilaginous tubular structure, lined with mucous membrane, located at the top of the trachea and below the root of the tongue and the hyoid bone. It is the essential sphincter guarding the entrance into the trachea and functioning secondarily as the organ of voice. [NIH] Laxative: An agent that acts to promote evacuation of the bowel; a cathartic or purgative. [EU]

Least-Squares Analysis: A principle of estimation in which the estimates of a set of parameters in a statistical model are those quantities minimizing the sum of squared differences between the observed values of a dependent variable and the values predicted by the model. [NIH] Left ventricular assist device: A mechanical device used to increase the heart's pumping ability. [NIH] Lethal: Deadly, fatal. [EU] Leukemia: Cancer of blood-forming tissue. [NIH] Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]

Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Ligation: Application of a ligature to tie a vessel or strangulate a part. [NIH] Likelihood Functions: Functions constructed from a statistical model and a set of observed data which give the probability of that data for various values of the unknown model parameters. Those parameter values that maximize the probability are the maximum likelihood estimates of the parameters. [NIH] Linear Models: Statistical models in which the value of a parameter for a given value of a factor is assumed to be equal to a + bx, where a and b are constants. The models predict a linear regression. [NIH] Lip: Either of the two fleshy, full-blooded margins of the mouth. [NIH] Lipid: Fat. [NIH]

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Lipid Peroxidation: Peroxidase catalyzed oxidation of lipids using hydrogen peroxide as an electron acceptor. [NIH] Liposarcoma: A rare cancer of the fat cells. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Liver Cirrhosis: Liver disease in which the normal microcirculation, the gross vascular anatomy, and the hepatic architecture have been variably destroyed and altered with fibrous septa surrounding regenerated or regenerating parenchymal nodules. [NIH] Liver scan: An image of the liver created on a computer screen or on film. A radioactive substance is injected into a blood vessel and travels through the bloodstream. It collects in the liver, especially in abnormal areas, and can be detected by the scanner. [NIH] Liver Transplantation: The transference of a part of or an entire liver from one human or animal to another. [NIH] Lobe: A portion of an organ such as the liver, lung, breast, or brain. [NIH] Localization: The process of determining or marking the location or site of a lesion or disease. May also refer to the process of keeping a lesion or disease in a specific location or site. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Logistic Models: Statistical models which describe the relationship between a qualitative dependent variable (that is, one which can take only certain discrete values, such as the presence or absence of a disease) and an independent variable. A common application is in epidemiology for estimating an individual's risk (probability of a disease) as a function of a given risk factor. [NIH] Loop: A wire usually of platinum bent at one end into a small loop (usually 4 mm inside diameter) and used in transferring microorganisms. [NIH] Low Back Pain: Acute or chronic pain in the lumbar or sacral regions, which may be associated with musculo-ligamentous sprains and strains; intervertebral disk displacement; and other conditions. [NIH] Lower Esophageal Ring: An abnormal ring of tissue that may partially block the lower esophagus. Also called Schatzki's ring. [NIH] Lower Esophageal Sphincter: The muscle between the esophagus and stomach. When a person swallows, this muscle relaxes to let food pass from the esophagus to the stomach. It stays closed at other times to keep stomach contents from flowing back into the esophagus. [NIH]

Lumbar: Pertaining to the loins, the part of the back between the thorax and the pelvis. [EU] Lumen: The cavity or channel within a tube or tubular organ. [EU] Lung Transplantation: The transference of either one or both of the lungs from one human or animal to another. [NIH] Lung volume: The amount of air the lungs hold. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]

Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph

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nodes, that produce and store cells that fight infection and disease. [NIH] Lymphatic system: The tissues and organs that produce, store, and carry white blood cells that fight infection and other diseases. This system includes the bone marrow, spleen, thymus, lymph nodes and a network of thin tubes that carry lymph and white blood cells. These tubes branch, like blood vessels, into all the tissues of the body. [NIH] Lymphocytes: White blood cells formed in the body's lymphoid tissue. The nucleus is round or ovoid with coarse, irregularly clumped chromatin while the cytoplasm is typically pale blue with azurophilic (if any) granules. Most lymphocytes can be classified as either T or B (with subpopulations of each); those with characteristics of neither major class are called null cells. [NIH] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Lymphoma: A general term for various neoplastic diseases of the lymphoid tissue. [NIH] Macula: A stain, spot, or thickening. Often used alone to refer to the macula retinae. [EU] Magnetic Resonance Imaging: Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. [NIH] Malabsorption: Impaired intestinal absorption of nutrients. [EU] Malformation: A morphologic developmental process. [EU]

defect

resulting

from

an

intrinsically

abnormal

Malignancy: A cancerous tumor that can invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malnutrition: A condition caused by not eating enough food or not eating a balanced diet. [NIH]

Manifest: Being the part or aspect of a phenomenon that is directly observable : concretely expressed in behaviour. [EU] Manometry: Tests that measure muscle pressure and movements in the GI tract. [NIH] Mastectomy: Surgery to remove the breast (or as much of the breast tissue as possible). [NIH] Mastication: The act and process of chewing and grinding food in the mouth. [NIH] Matrix metalloproteinase: A member of a group of enzymes that can break down proteins, such as collagen, that are normally found in the spaces between cells in tissues (i.e., extracellular matrix proteins). Because these enzymes need zinc or calcium atoms to work properly, they are called metalloproteinases. Matrix metalloproteinases are involved in wound healing, angiogenesis, and tumor cell metastasis. [NIH] Maxillary: Pertaining to the maxilla : the irregularly shaped bone that with its fellow forms the upper jaw. [EU] Maxillary Nerve: The intermediate sensory division of the trigeminal (5th cranial) nerve. The maxillary nerve carries general afferents from the intermediate region of the face including the lower eyelid, nose and upper lip, the maxillary teeth, and parts of the dura. [NIH]

Mechanical ventilation: Use of a machine called a ventilator or respirator to improve the exchange of air between the lungs and the atmosphere. [NIH] Medial: Lying near the midsaggital plane of the body; opposed to lateral. [NIH]

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Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Medical Records: Recording of pertinent information concerning patient's illness or illnesses. [NIH] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Melanin: The substance that gives the skin its color. [NIH] Melanocytes: Epidermal dendritic pigment cells which control long-term morphological color changes by alteration in their number or in the amount of pigment they produce and store in the pigment containing organelles called melanosomes. Melanophores are larger cells which do not exist in mammals. [NIH] Melanoma: A form of skin cancer that arises in melanocytes, the cells that produce pigment. Melanoma usually begins in a mole. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Membrane Proteins: Proteins which are found in membranes including cellular and intracellular membranes. They consist of two types, peripheral and integral proteins. They include most membrane-associated enzymes, antigenic proteins, transport proteins, and drug, hormone, and lectin receptors. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Meningitis: Inflammation of the meninges. When it affects the dura mater, the disease is termed pachymeningitis; when the arachnoid and pia mater are involved, it is called leptomeningitis, or meningitis proper. [EU] Menstruation: The normal physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus. [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Mesenteric: Pertaining to the mesentery : a membranous fold attaching various organs to the body wall. [EU] Mesentery: A layer of the peritoneum which attaches the abdominal viscera to the abdominal wall and conveys their blood vessels and nerves. [NIH] Meta-Analysis: A quantitative method of combining the results of independent studies (usually drawn from the published literature) and synthesizing summaries and conclusions which may be used to evaluate therapeutic effectiveness, plan new studies, etc., with application chiefly in the areas of research and medicine. [NIH] Metastasis: The spread of cancer from one part of the body to another. Tumors formed from cells that have spread are called "secondary tumors" and contain cells that are like those in the original (primary) tumor. The plural is metastases. [NIH] Metastatic: Having to do with metastasis, which is the spread of cancer from one part of the

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body to another. [NIH] Methionine: A sulfur containing essential amino acid that is important in many body functions. It is a chelating agent for heavy metals. [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microcirculation: The vascular network lying between the arterioles and venules; includes capillaries, metarterioles and arteriovenous anastomoses. Also, the flow of blood through this network. [NIH] Microorganism: An organism that can be seen only through a microscope. Microorganisms include bacteria, protozoa, algae, and fungi. Although viruses are not considered living organisms, they are sometimes classified as microorganisms. [NIH] Migration: The systematic movement of genes between populations of the same species, geographic race, or variety. [NIH] Mitochondria: Parts of a cell where aerobic production (also known as cell respiration) takes place. [NIH] Mitosis: A method of indirect cell division by means of which the two daughter nuclei normally receive identical complements of the number of chromosomes of the somatic cells of the species. [NIH] Mobility: Capability of movement, of being moved, or of flowing freely. [EU] Mobilization: The process of making a fixed part or stored substance mobile, as by separating a part from surrounding structures to make it accessible for an operative procedure or by causing release into the circulation for body use of a substance stored in the body. [EU] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Mononuclear: A cell with one nucleus. [NIH] Morphogenesis: The development of the form of an organ, part of the body, or organism. [NIH]

Morphological: Relating to the configuration or the structure of live organs. [NIH] Morphology: The science of the form and structure of organisms (plants, animals, and other forms of life). [NIH] Motility: The ability to move spontaneously. [EU] Motion Sickness: Sickness caused by motion, as sea sickness, train sickness, car sickness, and air sickness. [NIH] Mucosa: A mucous membrane, or tunica mucosa. [EU] Mucosal Lining: The lining of GI tract organs that makes mucus. [NIH]

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Mucus: The viscous secretion of mucous membranes. It contains mucin, white blood cells, water, inorganic salts, and exfoliated cells. [NIH] Multicenter study: A clinical trial that is carried out at more than one medical institution. [NIH]

Muscle Fibers: Large single cells, either cylindrical or prismatic in shape, that form the basic unit of muscle tissue. They consist of a soft contractile substance enclosed in a tubular sheath. [NIH] Muscular Atrophy: Derangement in size and number of muscle fibers occurring with aging, reduction in blood supply, or following immobilization, prolonged weightlessness, malnutrition, and particularly in denervation. [NIH] Muscular Dystrophies: A general term for a group of inherited disorders which are characterized by progressive degeneration of skeletal muscles. [NIH] Musculoskeletal System: Themuscles, bones, and cartilage of the body. [NIH] Myasthenia: Muscular debility; any constitutional anomaly of muscle. [EU] Mydriatic: 1. Dilating the pupil. 2. Any drug that dilates the pupil. [EU] Myocardial Ischemia: A disorder of cardiac function caused by insufficient blood flow to the muscle tissue of the heart. The decreased blood flow may be due to narrowing of the coronary arteries (coronary arteriosclerosis), to obstruction by a thrombus (coronary thrombosis), or less commonly, to diffuse narrowing of arterioles and other small vessels within the heart. Severe interruption of the blood supply to the myocardial tissue may result in necrosis of cardiac muscle (myocardial infarction). [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Myotonic Dystrophy: A condition presenting muscle weakness and wasting which may be progressive. [NIH] Narcotic: 1. Pertaining to or producing narcosis. 2. An agent that produces insensibility or stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has morphine-like actions. [EU] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] NCI: National Cancer Institute. NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the federal government's principal agency for cancer research. NCI conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://cancer.gov. [NIH] Necrotizing Enterocolitis: A condition in which part of the tissue in the intestines is destroyed. Occurs mainly in under-weight newborn babies. A temporary ileostomy may be necessary. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU] Neonatal period: The first 4 weeks after birth. [NIH] Neonatologist: Doctor who specializes in treating the diseases and disorders of newborn babies. [NIH] Neoplasia: Abnormal and uncontrolled cell growth. [NIH]

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Neoplastic: Pertaining to or like a neoplasm (= any new and abnormal growth); pertaining to neoplasia (= the formation of a neoplasm). [EU] Nephropathy: Disease of the kidneys. [EU] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Neuralgia: Intense or aching pain that occurs along the course or distribution of a peripheral or cranial nerve. [NIH] Neurogenic: Loss of bladder control caused by damage to the nerves controlling the bladder. [NIH] Neuromuscular: Pertaining to muscles and nerves. [EU] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropathy: A problem in any part of the nervous system except the brain and spinal cord. Neuropathies can be caused by infection, toxic substances, or disease. [NIH] Neurotransmitter: Any of a group of substances that are released on excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine, epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [EU] Neutrons: Electrically neutral elementary particles found in all atomic nuclei except light hydrogen; the mass is equal to that of the proton and electron combined and they are unstable when isolated from the nucleus, undergoing beta decay. Slow, thermal, epithermal, and fast neutrons refer to the energy levels with which the neutrons are ejected from heavier nuclei during their decay. [NIH] Nickel: A trace element with the atomic symbol Ni, atomic number 28, and atomic weight 58.69. It is a cofactor of the enzyme urease. [NIH] Nitric Oxide: A free radical gas produced endogenously by a variety of mammalian cells. It is synthesized from arginine by a complex reaction, catalyzed by nitric oxide synthase. Nitric oxide is endothelium-derived relaxing factor. It is released by the vascular endothelium and mediates the relaxation induced by some vasodilators such as acetylcholine and bradykinin. It also inhibits platelet aggregation, induces disaggregation of aggregated platelets, and inhibits platelet adhesion to the vascular endothelium. Nitric oxide activates cytosolic guanylate cyclase and thus elevates intracellular levels of cyclic GMP. [NIH]

Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Nitrous Oxide: Nitrogen oxide (N2O). A colorless, odorless gas that is used as an anesthetic and analgesic. High concentrations cause a narcotic effect and may replace oxygen, causing death by asphyxia. It is also used as a food aerosol in the preparation of whipping cream. [NIH]

Nonulcer Dyspepsia: Constant pain or discomfort in the upper GI tract. Symptoms include

Dictionary 285

burning, nausea, and bloating, but no ulcer. Possibly caused by muscle spasms. [NIH] Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleic acid: Either of two types of macromolecule (DNA or RNA) formed by polymerization of nucleotides. Nucleic acids are found in all living cells and contain the information (genetic code) for the transfer of genetic information from one generation to the next. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Observational study: An epidemiologic study that does not involve any intervention, experimental or otherwise. Such a study may be one in which nature is allowed to take its course, with changes in one characteristic being studied in relation to changes in other characteristics. Analytical epidemiologic methods, such as case-control and cohort study designs, are properly called observational epidemiology because the investigator is observing without intervention other than to record, classify, count, and statistically analyze results. [NIH] Occult: Obscure; concealed from observation, difficult to understand. [EU] Oesophagitis: Inflammation of the esophagus. [EU] Olfactory Bulb: Ovoid body resting on the cribriform plate of the ethmoid bone where the olfactory nerve terminates. The olfactory bulb contains several types of nerve cells including the mitral cells, on whose dendrites the olfactory nerve synapses, forming the olfactory glomeruli. The accessory olfactory bulb, which receives the projection from the vomeronasal organ via the vomeronasal nerve, is also included here. [NIH] Olfactory Nerve: The 1st cranial nerve. The olfactory nerve conveys the sense of smell. It is formed by the axons of olfactory receptor neurons which project from the olfactory epithelium (in the nasal epithelium) to the olfactory bulb. [NIH] Omentum: A fold of the peritoneum (the thin tissue that lines the abdomen) that surrounds the stomach and other organs in the abdomen. [NIH] Omeprazole: A highly effective inhibitor of gastric acid secretion used in the therapy of gastric ulcers and Zollinger-Ellison syndrome. The drug inhibits the H(+)-K(+)-ATPase (H(+)-K(+)-exchanging ATPase) in a pH-dependent manner. This ATPase is considered the proton pump in the secretory membrane of the parietal cell. [NIH] Oncogene: A gene that normally directs cell growth. If altered, an oncogene can promote or allow the uncontrolled growth of cancer. Alterations can be inherited or caused by an environmental exposure to carcinogens. [NIH] Opacity: Degree of density (area most dense taken for reading). [NIH] Operating Rooms: Facilities equipped for performing surgery. [NIH] Ophthalmic: Pertaining to the eye. [EU] Ophthalmology: A surgical specialty concerned with the structure and function of the eye and the medical and surgical treatment of its defects and diseases. [NIH] Optic Chiasm: The X-shaped structure formed by the meeting of the two optic nerves. At the optic chiasm the fibers from the medial part of each retina cross to project to the other side of the brain while the lateral retinal fibers continue on the same side. As a result each

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half of the brain receives information about the contralateral visual field from both eyes. [NIH]

Optic Nerve: The 2nd cranial nerve. The optic nerve conveys visual information from the retina to the brain. The nerve carries the axons of the retinal ganglion cells which sort at the optic chiasm and continue via the optic tracts to the brain. The largest projection is to the lateral geniculate nuclei; other important targets include the superior colliculi and the suprachiasmatic nuclei. Though known as the second cranial nerve, it is considered part of the central nervous system. [NIH] Organ Culture: The growth in aseptic culture of plant organs such as roots or shoots, beginning with organ primordia or segments and maintaining the characteristics of the organ. [NIH] Orthopaedic: Pertaining to the correction of deformities of the musculoskeletal system; pertaining to orthopaedics. [EU] Osteoporosis: Reduction of bone mass without alteration in the composition of bone, leading to fractures. Primary osteoporosis can be of two major types: postmenopausal osteoporosis and age-related (or senile) osteoporosis. [NIH] Ostomy: Surgical construction of an artificial opening (stoma) for external fistulization of a duct or vessel by insertion of a tube with or without a supportive stent. [NIH] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Ovaries: The pair of female reproductive glands in which the ova, or eggs, are formed. The ovaries are located in the pelvis, one on each side of the uterus. [NIH] Ovary: Either of the paired glands in the female that produce the female germ cells and secrete some of the female sex hormones. [NIH] Ovum: A female germ cell extruded from the ovary at ovulation. [NIH] Oxidants: Oxidizing agents or electron-accepting molecules in chemical reactions in which electrons are transferred from one molecule to another (oxidation-reduction). In vivo, it appears that phagocyte-generated oxidants function as tumor promoters or cocarcinogens rather than as complete carcinogens perhaps because of the high levels of endogenous antioxidant defenses. It is also thought that oxidative damage in joints may trigger the autoimmune response that characterizes the persistence of the rheumatoid disease process. [NIH]

Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU]

Oxidation-Reduction: A chemical reaction in which an electron is transferred from one molecule to another. The electron-donating molecule is the reducing agent or reductant; the electron-accepting molecule is the oxidizing agent or oxidant. Reducing and oxidizing agents function as conjugate reductant-oxidant pairs or redox pairs (Lehninger, Principles of Biochemistry, 1982, p471). [NIH] Oxidative Stress: A disturbance in the prooxidant-antioxidant balance in favor of the former, leading to potential damage. Indicators of oxidative stress include damaged DNA bases, protein oxidation products, and lipid peroxidation products (Sies, Oxidative Stress, 1991, pxv-xvi). [NIH] Oxides: Binary compounds of oxygen containing the anion O(2-). The anion combines with

Dictionary 287

metals to form alkaline oxides and non-metals to form acidic oxides. [NIH] Oxygen Consumption: The oxygen consumption is determined by calculating the difference between the amount of oxygen inhaled and exhaled. [NIH] Oxygenation: The process of supplying, treating, or mixing with oxygen. No:1245 oxygenation the process of supplying, treating, or mixing with oxygen. [EU] Oxygenator: An apparatus by which oxygen is introduced into the blood during circulation outside the body, as during open heart surgery. [NIH] Pachymeningitis: Inflammation of the dura mater of the brain, the spinal cord or the optic nerve. [NIH] Paediatric: Of or relating to the care and medical treatment of children; belonging to or concerned with paediatrics. [EU] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Palsies: Disease of the peripheral nervous system occurring usually after many years of increased lead absorption. [NIH] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Pancreatic: Having to do with the pancreas. [NIH] Pancreatic cancer: Cancer of the pancreas, a salivary gland of the abdomen. [NIH] Pancreatic Juice: The fluid containing digestive enzymes secreted by the pancreas in response to food in the duodenum. [NIH] Pancreatitis: Acute or chronic inflammation of the pancreas, which may be asymptomatic or symptomatic, and which is due to autodigestion of a pancreatic tissue by its own enzymes. It is caused most often by alcoholism or biliary tract disease; less commonly it may be associated with hyperlipaemia, hyperparathyroidism, abdominal trauma (accidental or operative injury), vasculitis, or uraemia. [EU] Pancuronium: A bis-quaternary steroid that is a competitive nicotinic antagonist. As a neuromuscular blocking agent it is more potent than curare but has less effect on the circulatory system and on histamine release. [NIH] Paracentesis: A procedure in which fluid is withdrawn from a body cavity via a trocar and cannula, needle, or other hollow instrument. [NIH] Paralysis: Loss of ability to move all or part of the body. [NIH] Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Parenteral Nutrition: The administering of nutrients for assimilation and utilization by a patient who cannot maintain adequate nutrition by enteral feeding alone. Nutrients are administered by a route other than the alimentary canal (e.g., intravenously, subcutaneously). [NIH] Parietal: 1. Of or pertaining to the walls of a cavity. 2. Pertaining to or located near the parietal bone, as the parietal lobe. [EU] Parietal Lobe: Upper central part of the cerebral hemisphere. [NIH] Paroxysmal: Recurring in paroxysms (= spasms or seizures). [EU] Partnership Practice: A voluntary contract between two or more doctors who may or may

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not share responsibility for the care of patients, with proportional sharing of profits and losses. [NIH] Patch: A piece of material used to cover or protect a wound, an injured part, etc.: a patch over the eye. [NIH] Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH]

Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pathologic Processes: The abnormal mechanisms and forms involved in the dysfunctions of tissues and organs. [NIH] Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Patient Satisfaction: The degree to which the individual regards the health care service or product or the manner in which it is delivered by the provider as useful, effective, or beneficial. [NIH] Pelvic: Pertaining to the pelvis. [EU] Pelvis: The lower part of the abdomen, located between the hip bones. [NIH] Penicillin: An antibiotic drug used to treat infection. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Perception: The ability quickly and accurately to recognize similarities and differences among presented objects, whether these be pairs of words, pairs of number series, or multiple sets of these or other symbols such as geometric figures. [NIH] Percutaneous: Performed through the skin, as injection of radiopacque material in radiological examination, or the removal of tissue for biopsy accomplished by a needle. [EU] Perforation: 1. The act of boring or piercing through a part. 2. A hole made through a part or substance. [EU] Perfusion: Bathing an organ or tissue with a fluid. In regional perfusion, a specific area of the body (usually an arm or a leg) receives high doses of anticancer drugs through a blood vessel. Such a procedure is performed to treat cancer that has not spread. [NIH] Pericardial Effusion: Presence of fluid within the pericardium. [NIH] Pericardium: The fibroserous sac surrounding the heart and the roots of the great vessels. [NIH]

Perinatal: Pertaining to or occurring in the period shortly before and after birth; variously defined as beginning with completion of the twentieth to twenty-eighth week of gestation and ending 7 to 28 days after birth. [EU] Perineal: Pertaining to the perineum. [EU] Perineum: The area between the anus and the sex organs. [NIH] Peripheral Nervous System: The nervous system outside of the brain and spinal cord. The peripheral nervous system has autonomic and somatic divisions. The autonomic nervous system includes the enteric, parasympathetic, and sympathetic subdivisions. The somatic nervous system includes the cranial and spinal nerves and their ganglia and the peripheral sensory receptors. [NIH]

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Peristalsis: The rippling motion of muscles in the intestine or other tubular organs characterized by the alternate contraction and relaxation of the muscles that propel the contents onward. [NIH] Peritoneal: Having to do with the peritoneum (the tissue that lines the abdominal wall and covers most of the organs in the abdomen). [NIH] Peritoneal Cavity: The space enclosed by the peritoneum. It is divided into two portions, the greater sac and the lesser sac or omental bursa, which lies behind the stomach. The two sacs are connected by the foramen of Winslow, or epiploic foramen. [NIH] Peritoneum: Endothelial lining of the abdominal cavity, the parietal peritoneum covering the inside of the abdominal wall and the visceral peritoneum covering the bowel, the mesentery, and certain of the organs. The portion that covers the bowel becomes the serosal layer of the bowel wall. [NIH] Peritonitis: Inflammation of the peritoneum; a condition marked by exudations in the peritoneum of serum, fibrin, cells, and pus. It is attended by abdominal pain and tenderness, constipation, vomiting, and moderate fever. [EU] Petechiae: Pinpoint, unraised, round red spots under the skin caused by bleeding. [NIH] Phagocyte: An immune system cell that can surround and kill microorganisms and remove dead cells. Phagocytes include macrophages. [NIH] Phallic: Pertaining to the phallus, or penis. [EU] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Pharynx: The hollow tube about 5 inches long that starts behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that goes to the stomach). [NIH] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Phenylalanine: An aromatic amino acid that is essential in the animal diet. It is a precursor of melanin, dopamine, noradrenalin, and thyroxine. [NIH] Phosphodiesterase: Effector enzyme that regulates the levels of a second messenger, the cyclic GMP. [NIH] Phosphodiesterase Inhibitors: Compounds which inhibit or antagonize the biosynthesis or actions of phosphodiesterases. [NIH] Phospholipases: A class of enzymes that catalyze the hydrolysis of phosphoglycerides or glycerophosphatidates. EC 3.1.-. [NIH] Phospholipids: Lipids containing one or more phosphate groups, particularly those derived from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine (sphingolipids). They are polar lipids that are of great importance for the structure and function of cell membranes and are the most abundant of membrane lipids, although not stored in large amounts in the system. [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Phosphorylated: Attached to a phosphate group. [NIH] Phosphorylation: The introduction of a phosphoryl group into a compound through the formation of an ester bond between the compound and a phosphorus moiety. [NIH] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH]

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Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Pilot study: The initial study examining a new method or treatment. [NIH] Placenta: A highly vascular fetal organ through which the fetus absorbs oxygen and other nutrients and excretes carbon dioxide and other wastes. It begins to form about the eighth day of gestation when the blastocyst adheres to the decidua. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Platelet Activation: A series of progressive, overlapping events triggered by exposure of the platelets to subendothelial tissue. These events include shape change, adhesiveness, aggregation, and release reactions. When carried through to completion, these events lead to the formation of a stable hemostatic plug. [NIH] Platelet Aggregation: The attachment of platelets to one another. This clumping together can be induced by a number of agents (e.g., thrombin, collagen) and is part of the mechanism leading to the formation of a thrombus. [NIH] Platelets: A type of blood cell that helps prevent bleeding by causing blood clots to form. Also called thrombocytes. [NIH] Platinum: Platinum. A heavy, soft, whitish metal, resembling tin, atomic number 78, atomic weight 195.09, symbol Pt. (From Dorland, 28th ed) It is used in manufacturing equipment for laboratory and industrial use. It occurs as a black powder (platinum black) and as a spongy substance (spongy platinum) and may have been known in Pliny's time as "alutiae". [NIH]

Pleura: The thin serous membrane enveloping the lungs and lining the thoracic cavity. [NIH] Pleural: A circumscribed area of hyaline whorled fibrous tissue which appears on the surface of the parietal pleura, on the fibrous part of the diaphragm or on the pleura in the interlobar fissures. [NIH] Pleural cavity: A space enclosed by the pleura (thin tissue covering the lungs and lining the interior wall of the chest cavity). It is bound by thin membranes. [NIH] Pleural Effusion: Presence of fluid in the pleural cavity resulting from excessive transudation or exudation from the pleural surfaces. It is a sign of disease and not a diagnosis in itself. [NIH] Pneumonia: Inflammation of the lungs. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Polycystic: An inherited disorder characterized by many grape-like clusters of fluid-filled cysts that make both kidneys larger over time. These cysts take over and destroy working kidney tissue. PKD may cause chronic renal failure and end-stage renal disease. [NIH] Polyethylene: A vinyl polymer made from ethylene. It can be branched or linear. Branched or low-density polyethylene is tough and pliable but not to the same degree as linear

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polyethylene. Linear or high-density polyethylene has a greater hardness and tensile strength. Polyethylene is used in a variety of products, including implants and prostheses. [NIH]

Polyethylene Glycols: Alpha-Hydro-omega-hydroxypoly(oxy-1,2-ethanediyls). Additional polymers of ethylene oxide and water and their ethers. They vary in consistency from liquid to solid, depending on the molecular weight, indicated by a number following the name. Used as surfactants in industry, including foods, cosmetics and pharmaceutics; in biomedicine, as dispersing agents, solvents, ointment and suppository bases, vehicles, tablet excipients. Some specific groups are lauromagrogols, nonoxynols, octoxynols and poloxamers. [NIH] Polyglycolic Acid: Poly(oxy(1-oxo-1,2-ethanediyl)). A biocompatible polymer used as a surgical suture material. [NIH] Polymers: Compounds formed by the joining of smaller, usually repeating, units linked by covalent bonds. These compounds often form large macromolecules (e.g., polypeptides, proteins, plastics). [NIH] Polymorphic: Occurring in several or many forms; appearing in different forms at different stages of development. [EU] Polytetrafluoroethylene: Homopolymer of tetrafluoroethylene. Nonflammable, tough, inert plastic tubing or sheeting; used to line vessels, insulate, protect or lubricate apparatus; also as filter, coating for surgical implants or as prosthetic material. Synonyms: Fluoroflex; Fluoroplast; Ftoroplast; Halon; Polyfene; PTFE; Tetron. [NIH] Port: An implanted device through which blood may be withdrawn and drugs may be infused without repeated needle sticks. Also called a port-a-cath. [NIH] Port-a-cath: An implanted device through which blood may be withdrawn and drugs may be infused without repeated needle sticks. Also called a port. [NIH] Portal Hypertension: High blood pressure in the portal vein. This vein carries blood into the liver. Portal hypertension is caused by a blood clot. This is a common complication of cirrhosis. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postmenopausal: Refers to the time after menopause. Menopause is the time in a woman's life when menstrual periods stop permanently; also called "change of life." [NIH] Postnatal: Occurring after birth, with reference to the newborn. [EU] Postnatal Care: The care provided a woman following the birth of a child. [NIH] Postoperative: After surgery. [NIH] Postoperative Complications: Pathologic processes that affect patients after a surgical procedure. They may or may not be related to the disease for which the surgery was done, and they may or may not be direct results of the surgery. [NIH] Postoperative Period: The period following a surgical operation. [NIH] Postsynaptic: Nerve potential generated by an inhibitory hyperpolarizing stimulation. [NIH] Post-traumatic: Occurring as a result of or after injury. [EU] Potentiation: An overall effect of two drugs taken together which is greater than the sum of the effects of each drug taken alone. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government

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agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Predictive factor: A situation or condition that may increase a person's risk of developing a certain disease or disorder. [NIH] Prenatal: Existing or occurring before birth, with reference to the fetus. [EU] Preoperative: Preceding an operation. [EU] Prepuce: A covering fold of skin; often used alone to designate the preputium penis. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Private Practice: Practice of a health profession by an individual, offering services on a person-to-person basis, as opposed to group or partnership practice. [NIH] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Projection: A defense mechanism, operating unconsciously, whereby that which is emotionally unacceptable in the self is rejected and attributed (projected) to others. [NIH] Prolapse: The protrusion of an organ or part of an organ into a natural or artificial orifice. [NIH]

Proline: A non-essential amino acid that is synthesized from glutamic acid. It is an essential component of collagen and is important for proper functioning of joints and tendons. [NIH] Prophylaxis: An attempt to prevent disease. [NIH] Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Prostaglandin: Any of a group of components derived from unsaturated 20-carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway that are extremely potent mediators of a diverse group of physiologic processes. The abbreviation for prostaglandin is PG; specific compounds are designated by adding one of the letters A through I to indicate the type of substituents found on the hydrocarbon skeleton and a subscript (1, 2 or 3) to indicate the number of double bonds in the hydrocarbon skeleton e.g., PGE2. The predominant naturally occurring prostaglandins all have two double bonds and are synthesized from arachidonic acid (5,8,11,14-eicosatetraenoic acid) by the pathway shown in the illustration. The 1 series and 3 series are produced by the same pathway with fatty acids having one fewer double bond (8,11,14-eicosatrienoic acid or one more double bond (5,8,11,14,17-eicosapentaenoic acid) than arachidonic acid. The subscript a or ß indicates the configuration at C-9 (a denotes a substituent below the plane of the ring, ß, above the plane). The naturally occurring PGF's have the a configuration, e.g., PGF2a. All of the

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prostaglandins act by binding to specific cell-surface receptors causing an increase in the level of the intracellular second messenger cyclic AMP (and in some cases cyclic GMP also). The effect produced by the cyclic AMP increase depends on the specific cell type. In some cases there is also a positive feedback effect. Increased cyclic AMP increases prostaglandin synthesis leading to further increases in cyclic AMP. [EU] Prostaglandins A: (13E,15S)-15-Hydroxy-9-oxoprosta-10,13-dien-1-oic acid (PGA(1)); (5Z,13E,15S)-15-hydroxy-9-oxoprosta-5,10,13-trien-1-oic acid (PGA(2)); (5Z,13E,15S,17Z)-15hydroxy-9-oxoprosta-5,10,13,17-tetraen-1-oic acid (PGA(3)). A group of naturally occurring secondary prostaglandins derived from PGE. PGA(1) and PGA(2) as well as their 19hydroxy derivatives are found in many organs and tissues. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Prostatectomy: Complete or partial surgical removal of the prostate. Three primary approaches are commonly employed: suprapubic - removal through an incision above the pubis and through the urinary bladder; retropubic - as for suprapubic but without entering the urinary bladder; and transurethral (transurethral resection of prostate). [NIH] Prosthesis: An artificial replacement of a part of the body. [NIH] Prosthesis Design: The plan and delineation of prostheses in general or a specific prosthesis. [NIH]

Protein Kinases: A family of enzymes that catalyze the conversion of ATP and a protein to ADP and a phosphoprotein. EC 2.7.1.37. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Proteoglycans: Glycoproteins which have a very high polysaccharide content. [NIH] Proton Pump: Integral membrane proteins that transport protons across a membrane against a concentration gradient. This transport is driven by hydrolysis of ATP by H(+)transporting ATP synthase. [NIH] Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Psychiatric: Pertaining to or within the purview of psychiatry. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Psychogenic: Produced or caused by psychic or mental factors rather than organic factors. [EU]

Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Pulmonary: Relating to the lungs. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right

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ventricle and conveying unaerated blood to the lungs. [NIH] Pulmonary hypertension: Abnormally high blood pressure in the arteries of the lungs. [NIH] Pulposus: Prolapse of the nucleus pulposus into the body of the vertebra; necrobacillosis of rabbits. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]

Pupil: The aperture in the iris through which light passes. [NIH] Purpura: Purplish or brownish red discoloration, easily visible through the epidermis, caused by hemorrhage into the tissues. [NIH] Purulent: Consisting of or containing pus; associated with the formation of or caused by pus. [EU] Putrefaction: The process of decomposition of animal and vegetable matter by living organisms. [NIH] Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Quaternary: 1. Fourth in order. 2. Containing four elements or groups. [EU] Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not sufficiently so as to achieve the status of a taxon. [NIH] Racemic: Optically inactive but resolvable in the way of all racemic compounds. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radiation therapy: The use of high-energy radiation from x-rays, gamma rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body in the area near cancer cells (internal radiation therapy, implant radiation, or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Also called radiotherapy. [NIH] Radical prostatectomy: Surgery to remove the entire prostate. The two types of radical prostatectomy are retropubic prostatectomy and perineal prostatectomy. [NIH] Radioactive: Giving off radiation. [NIH] Radiofrequency ablation: The use of electrical current to destroy tissue. [NIH] Radiography: Examination of any part of the body for diagnostic purposes by means of roentgen rays, recording the image on a sensitized surface (such as photographic film). [NIH] Radiological: Pertaining to radiodiagnostic and radiotherapeutic procedures, and interventional radiology or other planning and guiding medical radiology. [NIH] Radiology: A specialty concerned with the use of x-ray and other forms of radiant energy in the diagnosis and treatment of disease. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Randomized clinical trial: A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the

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participants can choose which group. Using chance to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively. At the time of the trial, it is not known which treatment is best. It is the patient's choice to be in a randomized trial. [NIH] Randomized Controlled Trials: Clinical trials that involve at least one test treatment and one control treatment, concurrent enrollment and follow-up of the test- and control-treated groups, and in which the treatments to be administered are selected by a random process, such as the use of a random-numbers table. Treatment allocations using coin flips, odd-even numbers, patient social security numbers, days of the week, medical record numbers, or other such pseudo- or quasi-random processes, are not truly randomized and trials employing any of these techniques for patient assignment are designated simply controlled clinical trials. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Receptors, Serotonin: Cell-surface proteins that bind serotonin and trigger intracellular changes which influence the behavior of cells. Several types of serotonin receptors have been recognized which differ in their pharmacology, molecular biology, and mode of action. [NIH] Recombinant: A cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Recombination: The formation of new combinations of genes as a result of segregation in crosses between genetically different parents; also the rearrangement of linked genes due to crossing-over. [NIH] Rectal: By or having to do with the rectum. The rectum is the last 8 to 10 inches of the large intestine and ends at the anus. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recur: To occur again. Recurrence is the return of cancer, at the same site as the original (primary) tumor or in another location, after the tumor had disappeared. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Red Nucleus: A pinkish-yellow portion of the midbrain situated in the rostral mesencephalic tegmentum. It receives a large projection from the contralateral half of the cerebellum via the superior cerebellar peduncle and a projection from the ipsilateral motor cortex. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Reflux: The term used when liquid backs up into the esophagus from the stomach. [NIH] Refractory: Not readily yielding to treatment. [EU] Regeneration: The natural renewal of a structure, as of a lost tissue or part. [EU] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Regression Analysis: Procedures for finding the mathematical function which best describes the relationship between a dependent variable and one or more independent variables. In linear regression (see linear models) the relationship is constrained to be a straight line and least-squares analysis is used to determine the best fit. In logistic regression (see logistic models) the dependent variable is qualitative rather than continuously variable and likelihood functions are used to find the best relationship. In multiple regression the dependent variable is considered to depend on more than a single independent variable. [NIH]

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Regurgitation: A backward flowing, as the casting up of undigested food, or the backward flowing of blood into the heart, or between the chambers of the heart when a valve is incompetent. [EU] Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Reoperation: A repeat operation for the same condition in the same patient. It includes reoperation for reexamination, reoperation for disease progression or recurrence, or reoperation following operative failure. [NIH] Reperfusion: Restoration of blood supply to tissue which is ischemic due to decrease in normal blood supply. The decrease may result from any source including atherosclerotic obstruction, narrowing of the artery, or surgical clamping. It is primarily a procedure for treating infarction or other ischemia, by enabling viable ischemic tissue to recover, thus limiting further necrosis. However, it is thought that reperfusion can itself further damage the ischemic tissue, causing reperfusion injury. [NIH] Reperfusion Injury: Functional, metabolic, or structural changes, including necrosis, in ischemic tissues thought to result from reperfusion to ischemic areas of the tissue. The most common instance is myocardial reperfusion injury. [NIH] Resection: Removal of tissue or part or all of an organ by surgery. [NIH] Residual Volume: The volume of air remaining in the lungs at the end of a maximal expiration. Common abbreviation is RV. [NIH] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Respirator: A mechanical device that helps a patient breathe; a mechanical ventilator. [NIH] Respiratory distress syndrome: A lung disease that occurs primarily in premature infants; the newborn must struggle for each breath and blueing of its skin reflects the baby's inability to get enough oxygen. [NIH] Respiratory failure: Inability of the lungs to conduct gas exchange. [NIH] Respiratory Physiology: Functions and activities of the respiratory tract as a whole or of any of its parts. [NIH] Restoration: Broad term applied to any inlay, crown, bridge or complete denture which restores or replaces loss of teeth or oral tissues. [NIH] Resuscitation: The restoration to life or consciousness of one apparently dead; it includes such measures as artificial respiration and cardiac massage. [EU] Retina: The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outer-most layer is pigmented, whereas the inner nine layers are transparent. [NIH] Retinal: 1. Pertaining to the retina. 2. The aldehyde of retinol, derived by the oxidative enzymatic splitting of absorbed dietary carotene, and having vitamin A activity. In the retina, retinal combines with opsins to form visual pigments. One isomer, 11-cis retinal combines with opsin in the rods (scotopsin) to form rhodopsin, or visual purple. Another, all-trans retinal (trans-r.); visual yellow; xanthopsin) results from the bleaching of rhodopsin

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by light, in which the 11-cis form is converted to the all-trans form. Retinal also combines with opsins in the cones (photopsins) to form the three pigments responsible for colour vision. Called also retinal, and retinene1. [EU] Retinal Ganglion Cells: Cells of the innermost nuclear layer of the retina, the ganglion cell layer, which project axons through the optic nerve to the brain. They are quite variable in size and in the shapes of their dendritic arbors, which are generally confined to the inner plexiform layer. [NIH] Retinoblastoma: An eye cancer that most often occurs in children younger than 5 years. It occurs in hereditary and nonhereditary (sporadic) forms. [NIH] Retrograde: 1. Moving backward or against the usual direction of flow. 2. Degenerating, deteriorating, or catabolic. [EU] Retropubic: A potential space between the urinary bladder and the symphisis and body of the pubis. [NIH] Retropubic prostatectomy: Surgery to remove the prostate through an incision made in the abdominal wall. [NIH] Retrospective: Looking back at events that have already taken place. [NIH] Retrospective Studies: Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons. [NIH] Retrospective study: A study that looks backward in time, usually using medical records and interviews with patients who already have or had a disease. [NIH] Retroviral vector: RNA from a virus that is used to insert genetic material into cells. [NIH] Retrovirus: A member of a group of RNA viruses, the RNA of which is copied during viral replication into DNA by reverse transcriptase. The viral DNA is then able to be integrated into the host chromosomal DNA. [NIH] Rheumatoid: Resembling rheumatism. [EU] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Rod: A reception for vision, located in the retina. [NIH] Rotator: A muscle by which a part can be turned circularly. [NIH] Rotator Cuff: The musculotendinous sheath formed by the supraspinatus, infraspinatus, subscapularis, and teres minor muscles. These help stabilize the head of the humerus in the glenoid fossa and allow for rotation of the shoulder joint about its longitudinal axis. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Saphenous: Applied to certain structures in the leg, e. g. nerve vein. [NIH] Saphenous Vein: The vein which drains the foot and leg. [NIH] Saponins: Sapogenin glycosides. A type of glycoside widely distributed in plants. Each consists of a sapogenin as the aglycon moiety, and a sugar. The sapogenin may be a steroid or a triterpene and the sugar may be glucose, galactose, a pentose, or a methylpentose. Sapogenins are poisonous towards the lower forms of life and are powerful hemolytics when injected into the blood stream able to dissolve red blood cells at even extreme dilutions. [NIH]

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Scans: Pictures of structures inside the body. Scans often used in diagnosing, staging, and monitoring disease include liver scans, bone scans, and computed tomography (CT) or computerized axial tomography (CAT) scans and magnetic resonance imaging (MRI) scans. In liver scanning and bone scanning, radioactive substances that are injected into the bloodstream collect in these organs. A scanner that detects the radiation is used to create pictures. In CT scanning, an x-ray machine linked to a computer is used to produce detailed pictures of organs inside the body. MRI scans use a large magnet connected to a computer to create pictures of areas inside the body. [NIH] Scleroderma: A chronic disorder marked by hardening and thickening of the skin. Scleroderma can be localized or it can affect the entire body (systemic). [NIH] Sclerosis: A pathological process consisting of hardening or fibrosis of an anatomical structure, often a vessel or a nerve. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Scrotum: In males, the external sac that contains the testicles. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Secretory: Secreting; relating to or influencing secretion or the secretions. [NIH] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Semen: The thick, yellowish-white, viscid fluid secretion of male reproductive organs discharged upon ejaculation. In addition to reproductive organ secretions, it contains spermatozoa and their nutrient plasma. [NIH] Seminal vesicles: Glands that help produce semen. [NIH] Senile: Relating or belonging to old age; characteristic of old age; resulting from infirmity of old age. [NIH] Sensibility: The ability to receive, feel and appreciate sensations and impressions; the quality of being sensitive; the extend to which a method gives results that are free from false negatives. [NIH] Sepsis: The presence of bacteria in the bloodstream. [NIH] Septal: An abscess occurring at the root of the tooth on the proximal surface. [NIH] Septicemia: Systemic disease associated with the presence and persistence of pathogenic microorganisms or their toxins in the blood. Called also blood poisoning. [EU] Sequencing: The determination of the order of nucleotides in a DNA or RNA chain. [NIH] Serotonin: A biochemical messenger and regulator, synthesized from the essential amino acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis, and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the broad physiological actions and distribution of this biochemical mediator. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Sex Determination: The biological characteristics which distinguish human beings as female or male. [NIH]

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Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]

Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Sigmoid: 1. Shaped like the letter S or the letter C. 2. The sigmoid colon. [EU] Sigmoid Colon: The lower part of the colon that empties into the rectum. [NIH] Signal Transduction: The intercellular or intracellular transfer of information (biological activation/inhibition) through a signal pathway. In each signal transduction system, an activation/inhibition signal from a biologically active molecule (hormone, neurotransmitter) is mediated via the coupling of a receptor/enzyme to a second messenger system or to an ion channel. Signal transduction plays an important role in activating cellular functions, cell differentiation, and cell proliferation. Examples of signal transduction systems are the GABA-postsynaptic receptor-calcium ion channel system, the receptor-mediated T-cell activation pathway, and the receptor-mediated activation of phospholipases. Those coupled to membrane depolarization or intracellular release of calcium include the receptormediated activation of cytotoxic functions in granulocytes and the synaptic potentiation of protein kinase activation. Some signal transduction pathways may be part of larger signal transduction pathways; for example, protein kinase activation is part of the platelet activation signal pathway. [NIH] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Silicon: A trace element that constitutes about 27.6% of the earth's crust in the form of silicon dioxide. It does not occur free in nature. Silicon has the atomic symbol Si, atomic number 14, and atomic weight 28.09. [NIH] Silicon Dioxide: Silica. Transparent, tasteless crystals found in nature as agate, amethyst, chalcedony, cristobalite, flint, sand, quartz, and tridymite. The compound is insoluble in water or acids except hydrofluoric acid. [NIH] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Skull: The skeleton of the head including the bones of the face and the bones enclosing the brain. [NIH] Sleep apnea: A serious, potentially life-threatening breathing disorder characterized by repeated cessation of breathing due to either collapse of the upper airway during sleep or absence of respiratory effort. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Smoke Inhalation Injury: Pulmonary injury following the breathing in of toxic smoke from burning materials such as plastics, synthetics, building materials, etc. This injury is the most frequent cause of death in burn patients. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

Social Environment: The aggregate of social and cultural institutions, forms, patterns, and

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processes that influence the life of an individual or community. [NIH] Social Security: Government sponsored social insurance programs. [NIH] Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH] Soft tissue: Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body. [NIH] Solvent: 1. Dissolving; effecting a solution. 2. A liquid that dissolves or that is capable of dissolving; the component of a solution that is present in greater amount. [EU] Sound wave: An alteration of properties of an elastic medium, such as pressure, particle displacement, or density, that propagates through the medium, or a superposition of such alterations. [NIH] Spastic: 1. Of the nature of or characterized by spasms. 2. Hypertonic, so that the muscles are stiff and the movements awkward. 3. A person exhibiting spasticity, such as occurs in spastic paralysis or in cerebral palsy. [EU] Spasticity: A state of hypertonicity, or increase over the normal tone of a muscle, with heightened deep tendon reflexes. [EU] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Sperm: The fecundating fluid of the male. [NIH] Spermatic: A cord-like structure formed by the vas deferens and the blood vessels, nerves and lymphatics of the testis. [NIH] Sphincter: A ringlike band of muscle fibres that constricts a passage or closes a natural orifice; called also musculus sphincter. [EU] Spina bifida: A defect in development of the vertebral column in which there is a central deficiency of the vertebral lamina. [NIH] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spleen: An organ that is part of the lymphatic system. The spleen produces lymphocytes, filters the blood, stores blood cells, and destroys old blood cells. It is located on the left side of the abdomen near the stomach. [NIH] Splenectomy: An operation to remove the spleen. [NIH] Sporadic: Neither endemic nor epidemic; occurring occasionally in a random or isolated manner. [EU] Sprains and Strains: A collective term for muscle and ligament injuries without dislocation

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or fracture. A sprain is a joint injury in which some of the fibers of a supporting ligament are ruptured but the continuity of the ligament remains intact. A strain is an overstretching or overexertion of some part of the musculature. [NIH] Stabilization: The creation of a stable state. [EU] Staging: Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. [NIH]

Stasis: A word termination indicating the maintenance of (or maintaining) a constant level; preventing increase or multiplication. [EU] Steel: A tough, malleable, iron-based alloy containing up to, but no more than, two percent carbon and often other metals. It is used in medicine and dentistry in implants and instrumentation. [NIH] Stenosis: Narrowing or stricture of a duct or canal. [EU] Stent: A device placed in a body structure (such as a blood vessel or the gastrointestinal tract) to provide support and keep the structure open. [NIH] Sterility: 1. The inability to produce offspring, i.e., the inability to conceive (female s.) or to induce conception (male s.). 2. The state of being aseptic, or free from microorganisms. [EU] Sterilization: The destroying of all forms of life, especially microorganisms, by heat, chemical, or other means. [NIH] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stimulant: 1. Producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. An agent or remedy that produces stimulation. [EU]

Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stoma: A surgically created opening from an area inside the body to the outside. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Strangulation: Extreme compression or constriction of the trachea or of any part. [NIH] Streptococcal: Caused by infection due to any species of streptococcus. [NIH] Streptococcus: A genus of gram-positive, coccoid bacteria whose organisms occur in pairs or chains. No endospores are produced. Many species exist as commensals or parasites on man or animals with some being highly pathogenic. A few species are saprophytes and occur in the natural environment. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stricture: The abnormal narrowing of a body opening. Also called stenosis. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Stromal: Large, veil-like cell in the bone marrow. [NIH]

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Stromal Cells: Connective tissue cells of an organ found in the loose connective tissue. These are most often associated with the uterine mucosa and the ovary as well as the hematopoietic system and elsewhere. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subarachnoid: Situated or occurring between the arachnoid and the pia mater. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH] Subspecies: A category intermediate in rank between species and variety, based on a smaller number of correlated characters than are used to differentiate species and generally conditioned by geographical and/or ecological occurrence. [NIH] Substrate: A substance upon which an enzyme acts. [EU] Suction: The removal of secretions, gas or fluid from hollow or tubular organs or cavities by means of a tube and a device that acts on negative pressure. [NIH] Sulbactam: A beta-lactamase inhibitor with very weak antibacterial action. The compound prevents antibiotic destruction of beta-lactam antibiotics by inhibiting beta-lactamases, thus extending their spectrum activity. Combinations of sulbactam with beta-lactam antibiotics have been used successfully for the therapy of infections caused by organisms resistant to the antibiotic alone. [NIH] Sulfur: An element that is a member of the chalcogen family. It has an atomic symbol S, atomic number 16, and atomic weight 32.066. It is found in the amino acids cysteine and methionine. [NIH] Support group: A group of people with similar disease who meet to discuss how better to cope with their cancer and treatment. [NIH] Suppository: A medicated mass adapted for introduction into the rectal, vaginal, or urethral orifice of the body, suppository bases are solid at room temperature but melt or dissolve at body temperature. Commonly used bases are cocoa butter, glycerinated gelatin, hydrogenated vegetable oils, polyethylene glycols of various molecular weights, and fatty acid esters of polyethylene glycol. [EU] Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH] Surfactant: A fat-containing protein in the respiratory passages which reduces the surface tension of pulmonary fluids and contributes to the elastic properties of pulmonary tissue. [NIH]

Surgical Mesh: Any woven or knit material of open texture used in surgery for the repair, reconstruction, or substitution of tissue. The mesh is usually a synthetic fabric made of various polymers. It is occasionally made of metal. [NIH] Survival Rate: The proportion of survivors in a group, e.g., of patients, studied and followed over a period, or the proportion of persons in a specified group alive at the beginning of a time interval who survive to the end of the interval. It is often studied using life table methods. [NIH] Sympathectomy: The removal or interruption of some part of the sympathetic nervous system for therapeutic or research purposes. [NIH] Sympathetic Nervous System: The thoracolumbar division of the autonomic nervous

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system. Sympathetic preganglionic fibers originate in neurons of the intermediolateral column of the spinal cord and project to the paravertebral and prevertebral ganglia, which in turn project to target organs. The sympathetic nervous system mediates the body's response to stressful situations, i.e., the fight or flight reactions. It often acts reciprocally to the parasympathetic system. [NIH] Symphysis: A secondary cartilaginous joint. [NIH] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Synchrony: The normal physiologic sequencing of atrial and ventricular activation and contraction. [NIH] Syncope: A temporary suspension of consciousness due to generalized cerebral schemia, a faint or swoon. [EU] Syrinx: A fistula. [NIH] Systemic: Affecting the entire body. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Tamponade: The inserting of a tampon; a dressing is inserted firmly into a wound or body cavity, as the nose, uterus or vagina, principally for stopping hemorrhage. [NIH] Telangiectasia: The permanent enlargement of blood vessels, causing redness in the skin or mucous membranes. [NIH] Temporal: One of the two irregular bones forming part of the lateral surfaces and base of the skull, and containing the organs of hearing. [NIH] Tendon: A discrete band of connective tissue mainly composed of parallel bundles of collagenous fibers by which muscles are attached, or two muscles bellies joined. [NIH] Testicle: The male gonad where, in adult life, spermatozoa develop; the testis. [NIH] Testicular: Pertaining to a testis. [EU] Testis: Either of the paired male reproductive glands that produce the male germ cells and the male hormones. [NIH] Thalamic: Cell that reaches the lateral nucleus of amygdala. [NIH] Thalamic Diseases: Disorders of the centrally located thalamus, which integrates a wide range of cortical and subcortical information. Manifestations include sensory loss, movement disorders; ataxia, pain syndromes, visual disorders, a variety of neuropsychological conditions, and coma. Relatively common etiologies include cerebrovascular disorders; craniocerebral trauma; brain neoplasms; brain hypoxia; intracranial hemorrhages; and infectious processes. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thigh: A leg; in anatomy, any elongated process or part of a structure more or less comparable to a leg. [NIH] Thoracic: Having to do with the chest. [NIH] Thoracotomy: Surgical incision into the chest wall. [NIH]

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Thorax: A part of the trunk between the neck and the abdomen; the chest. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombin: An enzyme formed from prothrombin that converts fibrinogen to fibrin. (Dorland, 27th ed) EC 3.4.21.5. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thrombus: An aggregation of blood factors, primarily platelets and fibrin with entrapment of cellular elements, frequently causing vascular obstruction at the point of its formation. Some authorities thus differentiate thrombus formation from simple coagulation or clot formation. [EU] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tissue Banks: Centers for acquiring, characterizing, and storing organs or tissue for future use. [NIH] Tissue Culture: Maintaining or growing of tissue, organ primordia, or the whole or part of an organ in vitro so as to preserve its architecture and/or function (Dorland, 28th ed). Tissue culture includes both organ culture and cell culture. [NIH] Tolazoline: A vasodilator that apparently has direct actions on blood vessels and also increases cardiac output. Tolazoline can interact to some degree with histamine, adrenergic, and cholinergic receptors, but the mechanisms of its therapeutic effects are not clear. It is used in treatment of persistent pulmonary hypertension of the newborn. [NIH] Tomography: Imaging methods that result in sharp images of objects located on a chosen plane and blurred images located above or below the plane. [NIH] Tone: 1. The normal degree of vigour and tension; in muscle, the resistance to passive elongation or stretch; tonus. 2. A particular quality of sound or of voice. 3. To make permanent, or to change, the colour of silver stain by chemical treatment, usually with a heavy metal. [EU] Tonus: A state of slight tension usually present in muscles even when they are not undergoing active contraction. [NIH] Torsion: A twisting or rotation of a bodily part or member on its axis. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Trace element: Substance or element essential to plant or animal life, but present in extremely small amounts. [NIH] Trachea: The cartilaginous and membranous tube descending from the larynx and

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branching into the right and left main bronchi. [NIH] Traction: The act of pulling. [NIH] Transcriptase: An enzyme which catalyses the synthesis of a complementary mRNA molecule from a DNA template in the presence of a mixture of the four ribonucleotides (ATP, UTP, GTP and CTP). [NIH] Transcription Factors: Endogenous substances, usually proteins, which are effective in the initiation, stimulation, or termination of the genetic transcription process. [NIH] Transduction: The transfer of genes from one cell to another by means of a viral (in the case of bacteria, a bacteriophage) vector or a vector which is similar to a virus particle (pseudovirion). [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Translational: The cleavage of signal sequence that directs the passage of the protein through a cell or organelle membrane. [NIH] Translocation: The movement of material in solution inside the body of the plant. [NIH] Transplantation: Transference of a tissue or organ, alive or dead, within an individual, between individuals of the same species, or between individuals of different species. [NIH] Transverse Colon: The part of the colon that goes across the abdomen from right to left. [NIH]

Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Treatment Failure: A measure of the quality of health care by assessment of unsuccessful results of management and procedures used in combating disease, in individual cases or series. [NIH] Trigeminal: Cranial nerve V. It is sensory for the eyeball, the conjunctiva, the eyebrow, the skin of face and scalp, the teeth, the mucous membranes in the mouth and nose, and is motor to the muscles of mastication. [NIH] Trigeminal Nerve: The 5th and largest cranial nerve. The trigeminal nerve is a mixed motor and sensory nerve. The larger sensory part forms the ophthalmic, mandibular, and maxillary nerves which carry afferents sensitive to external or internal stimuli from the skin, muscles, and joints of the face and mouth and from the teeth. Most of these fibers originate from cells of the trigeminal ganglion and project to the trigeminal nucleus of the brain stem. The smaller motor part arises from the brain stem trigeminal motor nucleus and innervates the muscles of mastication. [NIH] Triglyceride: A lipid carried through the blood stream to tissues. Most of the body's fat tissue is in the form of triglycerides, stored for use as energy. Triglycerides are obtained primarily from fat in foods. [NIH] Trusses: A surgical device designed for retaining a hernia in a reduced state within the abdominal cavity. [NIH] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Tubal ligation: An operation to tie the fallopian tubes closed. This procedure prevents pregnancy by blocking the passage of eggs from the ovaries to the uterus. [NIH] Tuberous Sclerosis: A rare congenital disease in which the essential pathology is the appearance of multiple tumors in the cerebrum and in other organs, such as the heart or kidneys. [NIH]

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Tumor Necrosis Factor: Serum glycoprotein produced by activated macrophages and other mammalian mononuclear leukocytes which has necrotizing activity against tumor cell lines and increases ability to reject tumor transplants. It mimics the action of endotoxin but differs from it. It has a molecular weight of less than 70,000 kDa. [NIH] Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH] Ulcer: A localized necrotic lesion of the skin or a mucous surface. [NIH] Ulceration: 1. The formation or development of an ulcer. 2. An ulcer. [EU] Ultrasonography: The visualization of deep structures of the body by recording the reflections of echoes of pulses of ultrasonic waves directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1.6 to 10 megahertz. [NIH] Umbilical Arteries: Either of a pair of arteries originating from the internal iliac artery and passing through the umbilical cord to carry blood from the fetus to the placenta. [NIH] Umbilical Cord: The flexible structure, giving passage to the umbilical arteries and vein, which connects the embryo or fetus to the placenta. [NIH] Umbilicus: The pit in the center of the abdominal wall marking the point where the umbilical cord entered in the fetus. [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Urachal Cyst: Cyst occurring in a persistent portion of the urachus, presenting as an extraperitoneal mass in the umbilical region. It is characterized by abdominal pain, and fever if infected. It may rupture, leading to peritonitis, or it may drain through the umbilicus. [NIH] Urachus: The urinary canal of the fetus; postnatally it is usually a fibrous cord but occasionally persists as a vesicoumbilical fistula. [NIH] Uraemia: 1. An excess in the blood of urea, creatinine, and other nitrogenous end products of protein and amino acids metabolism; more correctly referred to as azotemia. 2. In current usage the entire constellation of signs and symptoms of chronic renal failure, including nausea, vomiting anorexia, a metallic taste in the mouth, a uraemic odour of the breath, pruritus, uraemic frost on the skin, neuromuscular disorders, pain and twitching in the muscles, hypertension, edema, mental confusion, and acid-base and electrolyte imbalances. [EU]

Urease: An enzyme that catalyzes the conversion of urea and water to carbon dioxide and ammonia. EC 3.5.1.5. [NIH] Ureter: One of a pair of thick-walled tubes that transports urine from the kidney pelvis to the bladder. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urinary Fistula: An abnormal passage in any organ of the urinary tract or between urinary organs and other organs. [NIH] Urinary Retention: Inability to urinate. The etiology of this disorder includes obstructive, neurogenic, pharmacologic, and psychogenic causes. [NIH] Urinary tract: The organs of the body that produce and discharge urine. These include the

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kidneys, ureters, bladder, and urethra. [NIH] Urinate: To release urine from the bladder to the outside. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Urogenital: Pertaining to the urinary and genital apparatus; genitourinary. [EU] Urography: Radiography of any part of the urinary tract. [NIH] Urology: A surgical specialty concerned with the study, diagnosis, and treatment of diseases of the urinary tract in both sexes and the genital tract in the male. It includes the specialty of andrology which addresses both male genital diseases and male infertility. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Vaccines: Suspensions of killed or attenuated microorganisms (bacteria, viruses, fungi, protozoa, or rickettsiae), antigenic proteins derived from them, or synthetic constructs, administered for the prevention, amelioration, or treatment of infectious and other diseases. [NIH]

Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH] Vaginal: Of or having to do with the vagina, the birth canal. [NIH] Varicocele: A complex of dilated veins which surround the testicle, usually on the left side. [NIH]

Varicose: The common ulcer in the lower third of the leg or near the ankle. [NIH] Varicose vein: An abnormal swelling and tortuosity especially of the superficial veins of the legs. [EU] Varix: An enlarged, dilated, and tortuous venous channel. [NIH] Vas Deferens: The excretory duct of the testes that carries spermatozoa. It rises from the scrotum and joins the seminal vesicles to form the ejaculatory duct. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasculitis: Inflammation of a blood vessel. [NIH] Vasoconstriction: Narrowing of the blood vessels without anatomic change, for which constriction, pathologic is used. [NIH] Vasodilator: An agent that widens blood vessels. [NIH] Vector: Plasmid or other self-replicating DNA molecule that transfers DNA between cells in nature or in recombinant DNA technology. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Venter: Belly. [NIH] Ventilation: 1. In respiratory physiology, the process of exchange of air between the lungs and the ambient air. Pulmonary ventilation (usually measured in litres per minute) refers to the total exchange, whereas alveolar ventilation refers to the effective ventilation of the alveoli, in which gas exchange with the blood takes place. 2. In psychiatry, verbalization of one's emotional problems. [EU] Ventilator: A breathing machine that is used to treat respiratory failure by promoting ventilation; also called a respirator. [NIH] Ventral: 1. Pertaining to the belly or to any venter. 2. Denoting a position more toward the

308 Hernia

belly surface than some other object of reference; same as anterior in human anatomy. [EU] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] Ventricular: Pertaining to a ventricle. [EU] Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH] Vertebrae: A bony unit of the segmented spinal column. [NIH] Vertebral: Of or pertaining to a vertebra. [EU] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Visceral: , from viscus a viscus) pertaining to a viscus. [EU] Vitreous: Glasslike or hyaline; often used alone to designate the vitreous body of the eye (corpus vitreum). [EU] Vitreous Body: The transparent, semigelatinous substance that fills the cavity behind the crystalline lens of the eye and in front of the retina. It is contained in a thin hyoid membrane and forms about four fifths of the optic globe. [NIH] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] Vocal cord: The vocal folds of the larynx. [NIH] Void: To urinate, empty the bladder. [NIH] Volvulus: A twisting of the stomach or large intestine. May be caused by the stomach being in the wrong position, a foreign substance, or abnormal joining of one part of the stomach or intestine to another. Volvulus can lead to blockage, perforation, peritonitis, and poor blood flow. [NIH] Watchful waiting: Closely monitoring a patient's condition but withholding treatment until symptoms appear or change. Also called observation. [NIH] Weight Gain: Increase in body weight over existing weight. [NIH] Wheezing: Breathing with a rasp or whistling sound; a sign of airway constriction or obstruction. [NIH] Windpipe: A rigid tube, 10 cm long, extending from the cricoid cartilage to the upper border of the fifth thoracic vertebra. [NIH] Womb: A hollow, thick-walled, muscular organ in which the impregnated ovum is developed into a child. [NIH] Wound Healing: Restoration of integrity to traumatized tissue. [NIH] Wound Infection: Invasion of the site of trauma by pathogenic microorganisms. [NIH] Xenograft: The cells of one species transplanted to another species. [NIH]

Dictionary 309

X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH] Yeasts: A general term for single-celled rounded fungi that reproduce by budding. Brewers' and bakers' yeasts are Saccharomyces cerevisiae; therapeutic dried yeast is dried yeast. [NIH]

311

INDEX A Abdominal Pain, 249, 289, 306 Aberrant, 30, 249 Ablate, 28, 249 Ablation, 249 Abscess, 64, 206, 249, 298 Acceptor, 249, 279, 286 Acetaminophen, 17, 249 Acetylcarnitine, 166, 167, 249 Acetylcholine, 249, 259, 284 Acidity, 9, 249 Acyl, 15, 249 Adaptability, 249, 258 Adenocarcinoma, 21, 72, 249 Adenosine, 249, 257, 289 Adhesions, 29, 140, 151, 162, 170, 174, 186, 187, 249 Adjustment, 147, 249 Adrenergic, 249, 264, 266, 304 Adverse Effect, 16, 250, 299 Aerophagia, 126, 250 Aerosol, 250, 284 Affinity, 250, 300 Agar, 166, 250, 262, 275 Agenesis, 40, 93, 250 Agonist, 17, 250, 264 Airway, 31, 58, 125, 250, 299, 308 Alendronate, 65, 250 Alertness, 250, 256 Algorithms, 250, 255 Alimentary, 71, 72, 79, 100, 165, 194, 236, 250, 287 Alkaline, 250, 254, 257, 287 Alkaloid, 250, 259 Allogeneic, 250, 272 Allograft, 114, 250 Alpha Particles, 250, 294 Alpha-Linolenic Acid, 15, 250 Alternative medicine, 212, 251 Alveoli, 251, 274, 307 Ambulant, 196, 251 Amino acid, 251, 253, 274, 282, 288, 289, 292, 293, 298, 302, 305, 306 Amphetamines, 251, 259 Ampicillin, 54, 210, 251 Ampulla, 251, 266 Anaesthesia, 52, 55, 58, 60, 72, 81, 82, 85, 103, 121, 125, 251

Anaesthetic, 99, 111, 251 Anal, 251, 269 Analgesic, 249, 251, 264, 284 Analogous, 165, 166, 251, 305 Anemia, 226, 234, 251 Anesthesia, 5, 6, 9, 37, 59, 70, 82, 90, 93, 112, 140, 170, 181, 185, 189, 211, 250, 251, 262 Anesthetics, 195, 251, 266 Aneurysm, 102, 105, 203, 251 Angina, 66, 251 Angina Pectoris, 66, 251 Angiogenesis, 252, 280 Animal model, 18, 26, 167, 252 Ankle, 252, 307 Anomalies, 11, 16, 20, 22, 29, 34, 60, 198, 213, 252 Antagonism, 252, 257 Antibacterial, 252, 300, 302 Antibiotic, 37, 201, 251, 252, 256, 288, 300, 302 Antibiotic Prophylaxis, 201, 252 Antibody, 250, 252, 260, 263, 274, 275, 276, 277, 281, 294 Antigen, 250, 252, 260, 274, 275, 276, 281 Anti-inflammatory, 249, 252, 263, 264, 271, 277 Anti-Inflammatory Agents, 252, 277 Antioxidant, 33, 252, 286 Antipyretic, 249, 252, 264 Anus, 195, 251, 252, 253, 256, 260, 269, 277, 288, 295 Anxiety, 14, 252 Aorta, 36, 102, 252, 265, 308 Aperture, 138, 252, 294 Aplasia, 16, 45, 252 Apnea, 252 Aponeurosis, 160, 161, 202, 253, 270 Apoptosis, 16, 253 Appendicitis, 36, 64, 87, 196, 253 Aqueous, 253, 254, 263, 266 Arachidonic Acid, 253, 292 Arginine, 253, 284 Arterial, 26, 74, 77, 253, 274, 293, 303 Arteries, 27, 74, 252, 253, 255, 262, 282, 283, 294, 306 Arterioles, 121, 253, 255, 257, 282, 283 Arteriosus, 253, 293

312 Hernia

Artery, 251, 253, 262, 265, 294, 296, 306 Arthropathy, 167, 253 Asphyxia, 253, 284 Aspiration, 21, 253 Assay, 15, 253 Asthenia, 166, 167, 253 Asymptomatic, 20, 198, 253, 287 Ataxia, 225, 226, 253, 303 Atresia, 16, 253 Atrial, 253, 303 Atrophy, 225, 226, 253 Autodigestion, 254, 287 Autologous, 16, 105, 151, 174, 254 Autopsy, 198, 202, 254 Avian, 19, 22, 254 Axonal, 20, 254 Axons, 254, 285, 286, 297 B Back Pain, 246, 254 Bacteria, 249, 252, 254, 265, 266, 267, 268, 270, 272, 282, 298, 300, 301, 305, 307 Bacteriophage, 254, 305 Barium, 5, 234, 235, 254 Basal Ganglia, 253, 254, 270 Basal Ganglia Diseases, 253, 254 Base, 90, 160, 161, 185, 254, 263, 277, 303, 306 Basement Membrane, 254, 267, 278 Belching, 222, 250, 254 Benign, 254, 270, 272 Beta-Lactamases, 254, 302 Bifida, 254 Bilateral, 39, 40, 48, 59, 83, 95, 97, 98, 99, 110, 254 Bile, 254, 255, 269, 270, 275, 277, 279, 301 Bile Acids, 255, 270, 301 Bile duct, 255, 275 Bile Pigments, 255, 277 Biliary, 197, 255, 287 Biliary Tract, 255, 287 Biochemical, 27, 159, 203, 255, 268, 298 Biological therapy, 255, 272 Biopsy, 246, 255, 288 Biotechnology, 31, 32, 195, 212, 221, 224, 225, 226, 227, 255 Bladder, 3, 10, 29, 41, 59, 75, 83, 114, 141, 142, 170, 171, 255, 261, 263, 275, 276, 284, 293, 297, 306, 307, 308 Bloating, 27, 255, 275, 285 Blood Coagulation, 255, 257, 269 Blood Platelets, 255, 298

Blood pressure, 164, 187, 255, 274, 275, 282, 291, 294, 300 Body Fluids, 255, 256, 265, 300 Body Image, 198, 255 Body Mass Index, 38, 164, 187, 255 Bolus, 22, 28, 255 Bolus infusion, 255 Bone Marrow, 255, 271, 279, 280, 301 Bone scan, 256, 298 Bowel Movement, 256, 264, 301 Bradykinin, 256, 284 Brain Stem, 256, 305 Branch, 243, 256, 280, 288, 300, 303 Breakdown, 29, 173, 256, 264, 270 Breast reconstruction, 101, 256 Broad Ligament, 199, 256, 268 Broad-spectrum, 251, 256 Bronchi, 256, 266, 305 Bronchial, 256, 274 Bronchopulmonary, 30, 256 Bronchopulmonary Dysplasia, 30, 256 Bupivacaine, 82, 256 Burns, 23, 166, 167, 256 Burns, Electric, 256 Bypass, 14, 40, 256 C Cachexia, 166, 167, 256 Cadaver, 206, 256 Caffeine, 17, 256 Calcium, 108, 257, 260, 280, 299 Cannula, 107, 145, 157, 184, 185, 257, 287 Capillary, 30, 256, 257, 308 Carbohydrate, 257, 271 Carbon Dioxide, 158, 257, 269, 270, 290, 296, 306 Carcinogenic, 257, 276, 301 Carcinogens, 257, 285, 286 Cardia, 21, 145, 165, 196, 207, 257 Cardiac, 11, 17, 31, 51, 52, 60, 126, 139, 145, 206, 257, 266, 268, 270, 283, 296, 301, 304 Cardiac Output, 257, 304 Cardiomegaly, 86, 257 Cardiovascular, 40, 42, 86, 102, 107, 257, 298 Carnitine, 15, 166, 167, 249, 257 Catheter, 75, 165, 257, 277 Catheterization, 44, 257, 277 Caudal, 55, 121, 258, 291 Causal, 258, 297 Cecum, 69, 258, 278 Cell Death, 108, 253, 258 Cell Differentiation, 21, 258, 299

Index 313

Cell Division, 225, 254, 258, 272, 282, 290 Cell proliferation, 258, 299 Cell Respiration, 258, 282, 296 Cell Survival, 258, 272 Central Nervous System, 249, 251, 256, 258, 259, 270, 272, 286, 298 Cerebellar, 253, 258, 295 Cerebral, 19, 253, 254, 256, 258, 266, 267, 269, 287, 300, 303 Cerebral Cortex, 253, 258, 267, 269 Cerebral Palsy, 258, 300 Cerebrum, 258, 305 Cervical, 107, 166, 167, 193, 258 Cervix, 258 Character, 251, 258, 263 Chest cavity, 203, 234, 258, 290 Chest wall, 151, 174, 258, 303 Chin, 74, 104, 110, 258, 281 Cholecystectomy, 50, 70, 259 Cholesterol, 255, 259, 301 Cholinergic, 259, 304 Choroid, 259, 262, 296 Chromatin, 253, 259, 280 Chromosomal, 18, 26, 259, 297 Chronic Disease, 256, 259 Chronic renal, 259, 290, 306 Cicatrix, 259 Cicatrization, 166, 167, 259 Circulatory system, 259, 287 Circumcision, 55, 201, 259 Cirrhosis, 101, 259, 291 Clamp, 182, 259 Clinical trial, 10, 25, 29, 77, 106, 133, 134, 221, 259, 262, 265, 283, 294, 295 Clone, 18, 259 Cloning, 255, 259 Coca, 259 Cocaine, 120, 259 Coenzyme, 166, 167, 259 Cofactor, 260, 284, 293 Collagen, 20, 23, 31, 59, 97, 166, 251, 254, 260, 268, 269, 270, 280, 290, 292 Collapse, 51, 160, 256, 260, 299 Colon, 9, 44, 57, 69, 87, 95, 102, 109, 129, 173, 225, 260, 275, 278, 299, 305 Colostomy, 196, 260 Comorbidity, 20, 260 Complement, 260, 261 Complementary and alternative medicine, 125, 130, 260 Complementary medicine, 14, 125, 261 Complementation, 18, 261

Compliance, 13, 27, 54, 261 Computational Biology, 221, 224, 261 Computed tomography, 44, 102, 261, 298 Computerized tomography, 5, 261 Conception, 261, 268, 301 Concomitant, 7, 261 Conduction, 247, 261 Cone, 153, 163, 175, 177, 178, 261 Conjunctiva, 261, 305 Connective Tissue, 157, 165, 176, 256, 260, 261, 269, 270, 279, 302, 303 Connective Tissue Cells, 261 Consciousness, 251, 261, 263, 296, 303 Constipation, 222, 261, 289 Constitutional, 261, 283 Constriction, 27, 261, 277, 301, 307, 308 Constriction, Pathologic, 261, 307 Consumption, 164, 187, 261, 287 Contamination, 55, 262 Contraindications, ii, 200, 262 Contralateral, 46, 47, 50, 85, 100, 116, 201, 262, 286, 295 Control group, 7, 262 Controlled study, 97, 262 Conus, 262, 293 Convalescence, 94, 181, 262 Coronary, 14, 252, 262, 282, 283 Coronary Circulation, 252, 262 Coronary Thrombosis, 262, 282, 283 Corpus, 72, 93, 262, 292, 308 Corpus Callosum, 93, 262 Cortex, 262, 292, 295 Corticosteroids, 262, 271 Cortisone, 262, 263 Cranial, 19, 62, 262, 272, 280, 284, 285, 286, 288, 305 Cryptorchidism, 40, 198, 262 Cues, 30, 262 Culture Media, 250, 262 Curare, 262, 287 Curative, 27, 263, 303 Cutaneous, 81, 166, 167, 263 Cyclic, 257, 263, 272, 284, 289, 293 Cyst, 56, 263, 306 Cystostomy, 75, 263 Cytokines, 30, 263 Cytoplasm, 253, 263, 272, 280 Cytoskeleton, 16, 263 Cytotoxic, 263, 299 D De novo, 17, 263 Decompression, 62, 263

314 Hernia

Degenerative, 262, 263, 273 Deletion, 49, 253, 263 Dementia, 57, 263 Density, 23, 255, 263, 285, 290, 300 Depolarization, 263, 299 Deuterium, 263, 274 Dexamethasone, 16, 263 Diagnostic procedure, 137, 212, 263 Diastolic, 264, 275 Diclofenac, 96, 264 Diclofenac Sodium, 264 Digestion, 222, 250, 255, 256, 264, 265, 275, 277, 279, 301 Digestive system, 135, 264, 270 Digestive tract, 264, 299 Dilatation, 6, 41, 120, 251, 264 Dilation, 180, 256, 264 Diploid, 261, 264, 290 Discrete, 17, 153, 179, 264, 279, 303 Disease Progression, 264, 296 Disposition, 157, 264 Dissection, 24, 139, 141, 148, 149, 170, 171, 201, 264 Distention, 16, 264 Diuresis, 257, 264 Diverticula, 264 Diverticulitis, 51, 102, 109, 264 Diverticulum, 264 Dopamine, 259, 264, 284, 289 Dorsal, 264, 291 Double-blind, 14, 54, 82, 265 Drive, ii, vi, 4, 31, 53, 119, 156, 171, 183, 197, 200, 206, 233, 265 Drug Interactions, 216, 265 Duct, 251, 257, 265, 267, 286, 297, 301, 307 Ductus Arteriosus, 120, 265 Duodenal Ulcer, 93, 265 Duodenum, 254, 265, 266, 287, 301 Dura mater, 265, 281, 287 Dysostosis, 103, 265 Dyspepsia, 222, 265, 276 Dysphagia, 6, 8, 27, 180, 265 Dysplasia, 226, 265 Dyspnea, 8, 265 Dystrophy, 225, 265 E Efficacy, 9, 25, 28, 55, 82, 167, 173, 265 Ejaculation, 265, 298 Elastic, 97, 146, 147, 185, 265, 300, 302 Elastin, 54, 260, 265, 268 Elective, 7, 14, 50, 55, 76, 82, 100, 265 Embolus, 8, 265, 276

Embryo, 258, 265, 306 Embryology, 189, 197, 199, 200, 201, 265 Emollient, 265, 271 Emphysema, 102, 128, 203, 265 Empyema, 6, 265 Emulsion, 265, 269 Endogenous, 264, 266, 286, 305 Endometrial, 266 Endometriosis, 17, 55, 56, 266 Endometrium, 266 Endoscope, 180, 266 Endothelial cell, 30, 266 Endothelium, 266, 284 Endothelium-derived, 266, 284 Endotoxin, 266, 306 End-stage renal, 259, 266, 290 Environmental Exposure, 266, 285 Environmental Health, 220, 222, 266 Enzymatic, 251, 257, 260, 266, 273, 296 Enzyme, 15, 247, 260, 266, 271, 272, 284, 289, 299, 302, 304, 305, 306, 308 Epidural, 62, 85, 266 Epigastric, 36, 56, 65, 66, 111, 144, 157, 197, 201, 266, 287 Epinephrine, 249, 264, 266, 284, 306 Epithelial, 21, 26, 30, 63, 249, 266, 267, 273, 278 Epithelial Cells, 26, 30, 267, 273, 278 Epithelium, 16, 29, 254, 266, 267, 270, 285 Equipment and Supplies, 134, 267 Erythrocytes, 251, 256, 267 Esophageal Manometry, 234, 235, 267 Esophageal Perforation, 49, 267 Esophagectomy, 35, 50, 267 Esophagitis, 8, 9, 21, 71, 73, 99, 200, 205, 207, 267 Essential Tremor, 225, 267 Estrogens, 267, 272 Ether, 21, 267 Ethnic Groups, 127, 267 Eukaryotic Cells, 267, 275 Evacuation, 261, 267, 278 Evoke, 267, 301 Exocrine, 267, 287 Expiration, 267, 269, 296 Expiratory, 267, 269 Expiratory Reserve Volume, 267, 269 Extracellular, 10, 25, 59, 261, 267, 268, 269, 280, 300 Extracellular Matrix, 10, 59, 261, 267, 268, 269, 280 Extracellular Matrix Proteins, 59, 268, 280

Index 315

Extracellular Space, 267, 268 Extracorporeal, 8, 37, 69, 87, 114, 125, 126, 268 Extracorporeal Membrane Oxygenation, 8, 37, 69, 114, 125, 126, 268 Extravasation, 64, 268, 273 Extremity, 169, 268 F Faecal, 126, 268 Fallopian tube, 66, 268, 305 Falx, 202, 268 Family Planning, 221, 268 Fat, 8, 15, 151, 174, 182, 253, 256, 265, 268, 278, 279, 300, 302, 305 Fatty acids, 15, 167, 249, 268, 292 Feces, 261, 268, 301 Femur, 268 Fetal Blood, 265, 268 Fetal Monitoring, 24, 268 Fetus, 27, 32, 73, 93, 210, 268, 290, 292, 306, 307 Fibrin, 159, 255, 268, 289, 304 Fibrinogen, 268, 304 Fibroblasts, 29, 261, 269 Fibronectins, 268, 269 Fibrosis, 21, 226, 269, 298 Fissure, 262, 269 Fistula, 45, 269, 303, 306 Fixation, 11, 20, 62, 105, 142, 144, 159, 184, 210, 269 Flatulence, 222, 269 Flatus, 269, 270 Fluoroscopy, 27, 269 Fold, 43, 153, 177, 178, 256, 269, 281, 285, 292 Foramen, 35, 42, 62, 69, 74, 196, 199, 258, 269, 273, 289 Forearm, 105, 255, 269 Fossa, 199, 269, 297 Fovea, 199, 269 Free Radicals, 252, 269 Functional Residual Capacity, 54, 269 G Gallbladder, 95, 164, 187, 249, 255, 259, 264, 269, 270 Gamma irradiation, 10, 270 Ganglion, 270, 297, 305 Gangrene, 200, 270 Gangrenous, 64, 232, 270 Gas, 13, 64, 100, 139, 158, 222, 250, 254, 257, 269, 270, 274, 275, 276, 284, 296, 302, 307

Gas exchange, 270, 274, 296, 307 Gas Gangrene, 100, 270 Gastrectomy, 44, 270 Gastric Juices, 139, 270 Gastric Mucosa, 180, 270 Gastrin, 270, 274 Gastritis, 72, 270 Gastroenterologist, 27, 270 Gastroenterology, 4, 5, 7, 13, 34, 36, 38, 39, 41, 47, 57, 58, 66, 69, 71, 72, 77, 88, 111, 234, 270 Gastrointestinal stromal tumor, 66, 270 Gastrointestinal tract, 165, 197, 234, 269, 270, 298, 301 Gastroscopy, 234, 270 Gelatin, 262, 270, 302 Gels, 166, 271 Gene, 15, 17, 21, 25, 67, 112, 131, 161, 166, 195, 226, 227, 255, 271, 285 Gene Expression, 15, 25, 67, 112, 226, 271 Gene Therapy, 21, 271 Genital, 82, 230, 271, 307 Genitourinary, 66, 166, 271, 307 Genotype, 271, 289 Germ Cells, 271, 286, 303 Gestation, 8, 19, 21, 24, 30, 110, 271, 288, 290 Gland, 262, 271, 279, 287, 293, 298, 301, 304 Glucocorticoid, 25, 67, 263, 271 Glucose, 167, 225, 271, 273, 276, 297 Glucuronic Acid, 271, 273 Glycerol, 15, 271, 289 Glycoprotein, 268, 271, 278, 306 Glycosaminoglycans, 268, 271 Gonad, 92, 272, 303 Gonadal, 272, 301 Gonadotropin, 17, 272 Governing Board, 272, 292 Grade, 13, 272 Graft, 29, 70, 185, 272, 274 Graft Rejection, 29, 272 Grafting, 272, 275 Gram-positive, 272, 301 Granulocytes, 272, 299 Granuloma, 121, 272 Growth factors, 30, 165, 167, 272 Guanylate Cyclase, 272, 284 H Haematoma, 68, 272 Haemorrhage, 73, 272 Headache, 257, 272

316 Hernia

Heart Transplantation, 108, 272 Heartburn, 8, 138, 139, 154, 200, 211, 233, 234, 235, 236, 273, 275 Hematoma, 62, 273 Hemoglobin, 251, 267, 273 Hemoglobinopathies, 271, 273 Hemoglobinuria, 225, 273 Hemorrhage, 65, 181, 272, 273, 294, 301, 303 Hemostasis, 273, 298 Heparin, 30, 273 Hepatic, 51, 166, 167, 273, 279 Hepatitis, 167, 273 Hepatocytes, 273 Herbicide, 21, 273 Hereditary, 273, 297 Heredity, 271, 273 Hernia, Hiatal, 232, 273 Herniated, 4, 6, 120, 133, 146, 155, 169, 193, 200, 235, 245, 273 Herniorrhaphy, 9, 78, 100, 106, 114, 116, 134, 163, 198, 199, 233, 273 Histamine, 273, 274, 287, 304 Histamine Release, 274, 287 Histology, 11, 19, 274 Hoarseness, 234, 274, 278 Homologous, 18, 271, 274, 303 Hormonal, 73, 198, 253, 274 Hormonal therapy, 198, 274 Hormone, 17, 30, 166, 167, 262, 266, 270, 274, 276, 281, 292, 299, 304 Hormone therapy, 274 Host, 254, 274, 297 Humoral, 272, 274 Hyaline membrane disease, 26, 274 Hybrid, 259, 274 Hydrogen, 13, 249, 254, 257, 263, 268, 274, 279, 282, 284, 286, 293 Hydrolysis, 254, 274, 289, 293 Hydroxylysine, 260, 274 Hydroxyproline, 251, 260, 274 Hyperbilirubinemia, 274, 277 Hyperplasia, 21, 274 Hypersensitivity, 15, 274 Hypertension, 164, 187, 272, 274, 291, 306 Hypertrophy, 257, 274, 275 Hypoplasia, 16, 18, 19, 21, 22, 24, 25, 26, 29, 40, 52, 61, 95, 125, 275 Hypotensive, 13, 28, 275 Hysterectomy, 113, 275

I Id, 122, 128, 230, 231, 235, 236, 242, 244, 275 Ileostomy, 275, 283 Ileum, 95, 258, 275 Immaturity, 21, 30, 275 Immune response, 252, 262, 272, 275, 308 Immunodeficiency, 225, 275 Immunodiffusion, 250, 275 Immunoelectrophoresis, 250, 275 Immunosuppressive, 271, 275 Impaction, 144, 157, 183, 275 Impairment, 63, 253, 275, 277, 281 Implantation, 17, 23, 80, 142, 152, 154, 261, 275 In situ, 19, 275 In Situ Hybridization, 19, 275 In vitro, 17, 25, 30, 31, 165, 166, 167, 271, 275, 304 In vivo, 15, 23, 25, 30, 165, 166, 271, 273, 275, 286 Incisional, 11, 35, 37, 41, 43, 48, 55, 63, 67, 69, 74, 75, 78, 82, 83, 94, 99, 103, 104, 115, 126, 190, 193, 196, 197, 201, 210, 230, 232, 275 Incompetence, 270, 275 Incontinence, 114, 275 Indicative, 13, 190, 275, 288, 307 Indigestion, 200, 275 Infarction, 62, 262, 276, 282, 283, 296 Infertility, 17, 151, 174, 276, 307 Infiltration, 60, 276 Inflammation, 199, 201, 234, 252, 253, 264, 267, 269, 270, 273, 276, 278, 281, 285, 287, 289, 290, 307 Initiation, 276, 305 Inlay, 105, 276, 296 Insufflation, 27, 276 Insulin, 167, 276 Insulin-dependent diabetes mellitus, 276 Insulin-like, 167, 276 Intercostal, 104, 115, 276 Internal Medicine, 270, 276 Interstitial, 165, 268, 276, 277 Intervertebral, 54, 133, 166, 167, 173, 273, 276, 279 Intervertebral Disk Displacement, 276, 279 Intestinal, 5, 23, 52, 77, 81, 83, 110, 139, 144, 157, 166, 167, 183, 192, 195, 196, 200, 276, 277, 280 Intestinal Obstruction, 5, 52, 83, 110, 277

Index 317

Intestine, 6, 64, 144, 157, 164, 169, 172, 181, 182, 183, 194, 232, 256, 277, 278, 289, 308 Intracellular, 257, 276, 277, 281, 284, 293, 295, 299 Intramuscular, 112, 277, 287 Intraperitoneal, 77, 78, 116, 185, 277 Intravenous, 96, 277, 287 Intrinsic, 28, 250, 254, 277 Intubation, 257, 277 Invasive, 9, 24, 26, 85, 143, 147, 155, 172, 174, 182, 230, 277, 280 Involuntary, 254, 267, 277, 283 Ions, 249, 254, 274, 277 Irradiation, 277 Ischemia, 20, 200, 253, 277, 296 J Jaundice, 43, 53, 77, 274, 277 Joint, 17, 253, 277, 297, 301, 303 K Kb, 220, 277 Ketorolac, 96, 277 Keyhole, 162, 187, 210, 277 Kidney Disease, 135, 220, 226, 231, 236, 277 Kidney Pelvis, 277, 306 Kinetic, 176, 277 L Lacrimal, 127, 278 Lacrimal gland, 127, 278 Laminin, 254, 268, 278 Laparotomy, 11, 25, 52, 120, 145, 202, 278 Large Intestine, 165, 258, 264, 277, 278, 295, 299, 308 Laryngitis, 21, 278 Larynx, 278, 304, 308 Laxative, 250, 278 Least-Squares Analysis, 278, 295 Left ventricular assist device, 80, 278 Lethal, 45, 278 Leukemia, 225, 271, 278 Leukocytes, 256, 263, 272, 278, 306 Library Services, 242, 278 Ligament, 202, 278, 293, 300 Ligation, 24, 35, 81, 126, 278 Likelihood Functions, 278, 295 Linear Models, 278, 295 Lip, 139, 278, 280 Lipid, 15, 271, 276, 278, 279, 286, 305 Lipid Peroxidation, 279, 286 Liposarcoma, 66, 82, 279 Liver Cirrhosis, 48, 279 Liver scan, 279, 298

Liver Transplantation, 42, 43, 75, 77, 83, 85, 279 Lobe, 45, 207, 279 Localization, 107, 279 Localized, 269, 272, 273, 276, 278, 279, 290, 298, 306 Logistic Models, 279, 295 Loop, 36, 53, 143, 144, 146, 148, 149, 157, 168, 172, 183, 232, 273, 275, 279 Low Back Pain, 129, 133, 279 Lower Esophageal Ring, 180, 279 Lumbar, 36, 40, 50, 108, 113, 133, 193, 194, 197, 254, 276, 279 Lumen, 26, 139, 169, 180, 257, 279 Lung Transplantation, 40, 108, 279 Lung volume, 61, 279 Lymph, 64, 140, 170, 246, 258, 259, 266, 279, 280 Lymph node, 64, 140, 170, 246, 258, 279, 280 Lymphatic, 266, 276, 279, 280, 300 Lymphatic system, 279, 280, 300 Lymphocytes, 252, 278, 279, 280, 300 Lymphoid, 262, 280 Lymphoma, 64, 225, 230, 280 M Macula, 269, 280 Magnetic Resonance Imaging, 61, 68, 280, 298 Malabsorption, 225, 280 Malformation, 18, 19, 26, 280 Malignancy, 196, 198, 247, 280 Malignant, 225, 249, 270, 280 Malnutrition, 253, 256, 280, 283 Manifest, 254, 280 Manometry, 8, 27, 28, 280 Mastectomy, 256, 280 Mastication, 280, 305 Matrix metalloproteinase, 59, 280 Maxillary, 280, 305 Maxillary Nerve, 280, 305 Mechanical ventilation, 52, 54, 73, 256, 280 Medial, 6, 162, 186, 187, 280, 285 Mediator, 281, 298 Medical Records, 281, 297 MEDLINE, 221, 224, 226, 281 Melanin, 281, 289, 306 Melanocytes, 281 Melanoma, 225, 281 Membrane Proteins, 281, 293 Memory, 145, 185, 263, 281 Meninges, 258, 265, 281

318 Hernia

Meningitis, 114, 281 Menstruation, 164, 187, 281 Mental, iv, 10, 89, 135, 220, 223, 225, 227, 258, 263, 264, 275, 281, 293, 306 Mental Disorders, 135, 281, 293 Mesenteric, 83, 121, 127, 194, 281 Mesentery, 194, 281, 289 Meta-Analysis, 101, 116, 281 Metastasis, 280, 281 Metastatic, 37, 203, 281 Methionine, 167, 282, 302 MI, 41, 90, 164, 176, 187, 248, 282 Microcirculation, 279, 282 Microorganism, 260, 282, 308 Migration, 5, 10, 30, 72, 84, 173, 282 Mitochondria, 249, 282 Mitosis, 253, 282 Mobility, 28, 282 Mobilization, 105, 159, 184, 282 Modification, 154, 155, 251, 282, 294 Molecule, 30, 252, 254, 259, 260, 266, 273, 274, 277, 282, 286, 295, 299, 305, 307 Monitor, 24, 47, 282, 285 Mononuclear, 272, 282, 306 Morphogenesis, 26, 282 Morphological, 41, 63, 265, 281, 282 Morphology, 16, 17, 19, 282 Motility, 9, 35, 65, 69, 282, 298 Motion Sickness, 282, 283 Mucosa, 270, 282, 302 Mucosal Lining, 201, 282 Mucus, 282, 283 Multicenter study, 62, 94, 283 Muscle Fibers, 283 Muscular Atrophy, 225, 283 Muscular Dystrophies, 265, 283 Musculoskeletal System, 283, 286 Myasthenia, 166, 167, 283 Mydriatic, 264, 283 Myocardial Ischemia, 251, 283 Myocardium, 251, 282, 283 Myotonic Dystrophy, 225, 283 N Narcotic, 283, 284 Nausea, 5, 275, 283, 285, 306 NCI, 1, 135, 219, 283 Necrotizing Enterocolitis, 24, 283 Need, 3, 10, 25, 52, 140, 141, 142, 148, 150, 151, 166, 170, 171, 172, 173, 181, 182, 189, 197, 205, 213, 222, 233, 235, 238, 259, 280, 283

Neonatal, 4, 12, 16, 19, 22, 24, 29, 30, 41, 44, 47, 53, 72, 76, 87, 96, 283 Neonatal period, 16, 283 Neonatologist, 24, 283 Neoplasia, 225, 283, 284 Neoplastic, 280, 284 Nephropathy, 277, 284 Nervous System, 225, 258, 281, 284, 288, 303 Neuralgia, 166, 167, 284 Neurogenic, 284, 306 Neuromuscular, 249, 284, 287, 306 Neuronal, 167, 284 Neurons, 259, 284, 285, 303 Neuropathy, 89, 284 Neurotransmitter, 249, 251, 256, 264, 274, 284, 299 Neutrons, 250, 277, 284, 294 Nickel, 144, 284 Nitric Oxide, 27, 29, 88, 284 Nitrogen, 250, 268, 269, 284, 305 Nitrous Oxide, 6, 284 Nonulcer Dyspepsia, 222, 284 Nuclear, 15, 59, 64, 71, 112, 115, 254, 267, 270, 285, 297 Nuclei, 250, 271, 280, 282, 284, 285, 286, 293 Nucleic acid, 275, 284, 285 Nucleus, 245, 253, 254, 259, 263, 267, 276, 280, 282, 284, 285, 293, 294, 303, 305 O Observational study, 24, 285 Occult, 50, 65, 79, 110, 113, 285 Oesophagitis, 35, 72, 145, 285 Olfactory Bulb, 285 Olfactory Nerve, 166, 167, 285 Omentum, 6, 69, 164, 194, 206, 285 Omeprazole, 9, 285 Oncogene, 225, 285 Opacity, 263, 285 Operating Rooms, 185, 285 Ophthalmic, 127, 285, 305 Ophthalmology, 269, 285 Optic Chiasm, 285, 286 Optic Nerve, 166, 167, 285, 286, 287, 296, 297 Organ Culture, 286, 304 Orthopaedic, 11, 286 Osteoporosis, 166, 167, 250, 286 Ostomy, 9, 104, 286 Outpatient, 233, 286 Ovaries, 3, 286, 305

Index 319

Ovary, 66, 92, 95, 272, 286, 302 Ovum, 271, 286, 292, 308 Oxidants, 25, 286 Oxidation, 15, 249, 252, 279, 286 Oxidation-Reduction, 286 Oxidative Stress, 33, 286 Oxides, 27, 286 Oxygen Consumption, 287, 296 Oxygenation, 12, 29, 87, 287 Oxygenator, 268, 287 P Pachymeningitis, 281, 287 Paediatric, 43, 45, 55, 57, 72, 121, 287 Palliative, 287, 303 Palsies, 19, 287 Pancreas, 26, 197, 249, 264, 270, 276, 287 Pancreatic, 72, 165, 225, 257, 270, 287 Pancreatic cancer, 225, 287 Pancreatic Juice, 270, 287 Pancreatitis, 36, 72, 77, 287 Pancuronium, 96, 287 Paracentesis, 32, 103, 287 Paralysis, 108, 166, 167, 262, 287, 300 Parenteral, 44, 287 Parenteral Nutrition, 44, 287 Parietal, 142, 157, 285, 287, 289, 290 Parietal Lobe, 287 Paroxysmal, 225, 251, 287 Partnership Practice, 287, 292 Pathogenesis, 12, 41, 100, 167, 198, 202, 288 Pathologic, 93, 196, 253, 255, 262, 274, 288, 291 Pathologic Processes, 253, 288 Pathophysiology, 5, 7, 27, 29, 71, 192, 197, 198, 288 Patient Education, 193, 205, 232, 235, 240, 242, 248, 288 Patient Satisfaction, 14, 288 Pelvic, 85, 109, 125, 173, 197, 202, 211, 266, 288, 293 Pelvis, 249, 256, 279, 286, 288, 307 Penicillin, 251, 252, 288 Peptide, 251, 288, 293 Perception, 261, 288 Percutaneous, 43, 55, 79, 95, 98, 100, 184, 185, 288 Perforation, 6, 23, 32, 51, 57, 65, 83, 94, 200, 252, 269, 288, 308 Perfusion, 5, 288 Pericardial Effusion, 33, 288 Pericardium, 288

Perinatal, 33, 35, 51, 61, 93, 95, 114, 288 Perineal, 33, 94, 95, 125, 190, 196, 197, 288, 294 Perineum, 288 Peripheral Nervous System, 284, 287, 288 Peristalsis, 8, 22, 153, 179, 289 Peritoneal, 4, 20, 25, 47, 74, 111, 153, 157, 177, 178, 185, 196, 197, 199, 207, 277, 289 Peritoneal Cavity, 185, 199, 277, 289 Peritoneum, 140, 142, 157, 161, 170, 185, 194, 197, 202, 256, 281, 285, 289 Peritonitis, 181, 196, 289, 306, 308 Petechiae, 272, 289 Phagocyte, 286, 289 Phallic, 269, 289 Pharmacologic, 19, 28, 251, 289, 304, 306 Pharynx, 4, 165, 270, 289 Phenotype, 18, 22, 261, 289 Phenylalanine, 289, 306 Phosphodiesterase, 27, 289 Phosphodiesterase Inhibitors, 27, 289 Phospholipases, 289, 299 Phospholipids, 268, 289 Phosphorus, 257, 289 Phosphorylated, 259, 289 Phosphorylation, 25, 289 Physical Examination, 98, 198, 201, 289 Physiologic, 4, 28, 192, 196, 250, 268, 281, 290, 292, 295, 303 Physiology, 13, 18, 27, 29, 32, 198, 201, 213, 222, 235, 270, 290 Pilot study, 10, 290 Placenta, 268, 290, 292, 306 Plants, 250, 257, 259, 271, 273, 282, 290, 297, 304 Plasma, 268, 269, 271, 273, 290, 298 Platelet Activation, 290, 299 Platelet Aggregation, 284, 290 Platelets, 284, 290, 304 Platinum, 279, 290 Pleura, 290 Pleural, 6, 140, 290 Pleural cavity, 290 Pleural Effusion, 6, 290 Pneumonia, 21, 262, 290 Poisoning, 283, 290, 298 Polycystic, 226, 290 Polyethylene, 138, 290, 291, 302 Polyethylene Glycols, 291, 302 Polyglycolic Acid, 29, 291 Polymers, 173, 291, 293, 302 Polymorphic, 17, 291

320 Hernia

Polytetrafluoroethylene, 29, 34, 77, 291 Port, 36, 80, 144, 153, 157, 179, 291 Port-a-cath, 291 Portal Hypertension, 267, 291 Posterior, 62, 70, 85, 140, 170, 176, 206, 207, 251, 253, 254, 259, 264, 287, 291 Postmenopausal, 250, 286, 291 Postnatal, 4, 8, 61, 291 Postnatal Care, 8, 291 Postoperative Complications, 7, 213, 291 Postoperative Period, 42, 291 Postsynaptic, 291, 299 Post-traumatic, 95, 102, 291 Potentiation, 291, 299 Practice Guidelines, 223, 235, 291 Precursor, 253, 264, 266, 289, 292, 305, 306 Predictive factor, 48, 292 Prenatal, 4, 25, 38, 46, 49, 60, 61, 81, 93, 95, 101, 110, 121, 265, 292 Preoperative, 4, 5, 7, 13, 34, 93, 95, 102, 195, 232, 292 Prepuce, 259, 292 Prevalence, 5, 39, 154, 292 Private Practice, 69, 292 Progesterone, 292, 301 Progression, 211, 252, 292 Progressive, 30, 75, 96, 180, 258, 259, 263, 272, 283, 290, 292 Projection, 203, 285, 286, 292, 295 Prolapse, 173, 292, 294 Proline, 260, 274, 292 Prophylaxis, 37, 57, 166, 167, 292 Prospective study, 34, 292 Prostaglandin, 120, 292 Prostaglandins A, 292, 293 Prostate, 225, 293, 294, 297 Prostatectomy, 293, 294 Prosthesis, 37, 48, 55, 80, 84, 105, 113, 138, 140, 141, 142, 143, 144, 145, 151, 152, 153, 156, 158, 160, 161, 162, 163, 172, 173, 174, 175, 176, 177, 178, 179, 184, 185, 186, 293 Prosthesis Design, 184, 293 Protein Kinases, 25, 293 Protein S, 167, 195, 226, 255, 293 Proteoglycans, 254, 268, 293 Proton Pump, 9, 285, 293 Protons, 250, 274, 293, 294 Proximal, 5, 14, 105, 143, 144, 156, 169, 172, 183, 264, 293, 298 Psychiatric, 13, 281, 293 Psychiatry, 269, 293, 307

Psychic, 281, 293, 298 Psychogenic, 293, 306 Public Policy, 221, 293 Pulmonary Artery, 61, 255, 265, 293, 308 Pulmonary hypertension, 25, 26, 29, 88, 121, 294, 304 Pulposus, 245, 276, 294 Pulse, 282, 294 Pupil, 264, 283, 294 Purpura, 272, 294 Purulent, 249, 294 Putrefaction, 270, 294 Q Quality of Life, 76, 294 Quaternary, 287, 294 R Race, 82, 282, 294 Racemic, 82, 294 Radiation, 157, 251, 266, 269, 270, 277, 294, 298, 309 Radiation therapy, 270, 277, 294 Radical prostatectomy, 70, 294 Radioactive, 256, 274, 275, 277, 279, 285, 294, 298 Radiofrequency ablation, 51, 294 Radiography, 198, 294, 307 Radiological, 288, 294 Radiology, 42, 43, 86, 96, 97, 185, 198, 294 Randomized clinical trial, 25, 97, 294 Randomized Controlled Trials, 84, 295 Receptor, 26, 30, 31, 67, 252, 261, 264, 285, 295, 298, 299 Receptors, Serotonin, 295, 298 Recombinant, 166, 295, 307 Recombination, 271, 295 Rectal, 173, 195, 295, 302 Rectum, 87, 165, 195, 207, 252, 256, 260, 264, 269, 270, 275, 278, 293, 295, 299 Recur, 210, 295 Recurrence, 6, 9, 20, 43, 73, 98, 115, 134, 139, 143, 147, 148, 149, 150, 152, 160, 161, 168, 186, 198, 210, 211, 295, 296 Red Nucleus, 253, 295 Refer, 1, 9, 159, 184, 260, 269, 279, 280, 284, 295 Refractory, 29, 85, 295 Regeneration, 166, 167, 295 Regimen, 17, 265, 295 Regression Analysis, 38, 295 Regurgitation, 8, 234, 270, 273, 296 Remission, 295, 296 Reoperation, 75, 84, 296

Index 321

Reperfusion, 166, 167, 296 Reperfusion Injury, 296 Resection, 28, 52, 127, 293, 296 Residual Volume, 269, 296 Respiration, 28, 252, 257, 263, 282, 296 Respirator, 280, 296, 307 Respiratory distress syndrome, 256, 296 Respiratory failure, 36, 268, 296, 307 Respiratory Physiology, 296, 307 Restoration, 10, 127, 296, 308 Resuscitation, 4, 296 Retina, 167, 259, 262, 285, 286, 296, 297, 308 Retinal, 224, 261, 285, 286, 296, 297 Retinal Ganglion Cells, 286, 297 Retinoblastoma, 225, 297 Retrograde, 28, 112, 297 Retropubic, 40, 78, 97, 98, 293, 294, 297 Retropubic prostatectomy, 40, 78, 97, 98, 294, 297 Retrospective, 7, 8, 112, 297 Retrospective Studies, 8, 297 Retrospective study, 7, 297 Retroviral vector, 271, 297 Retrovirus, 19, 297 Rheumatoid, 286, 297 Risk factor, 72, 210, 213, 279, 292, 297 Rod, 143, 171, 172, 259, 297 Rotator, 173, 297 Rotator Cuff, 173, 297 S Salivary, 264, 287, 297 Salivary glands, 264, 297 Saphenous, 105, 297 Saphenous Vein, 105, 297 Saponins, 297, 301 Scans, 18, 298 Scleroderma, 139, 298 Sclerosis, 166, 167, 225, 298 Screening, 259, 298 Scrotum, 84, 198, 247, 262, 298, 307 Secretion, 274, 276, 283, 285, 298 Secretory, 285, 298 Seizures, 287, 298 Semen, 17, 129, 265, 293, 298 Seminal vesicles, 298, 307 Senile, 286, 298 Sensibility, 251, 298 Sepsis, 53, 114, 298 Septal, 33, 298 Septicemia, 53, 298 Sequencing, 298, 303

Serotonin, 120, 284, 295, 298, 305 Serum, 167, 260, 272, 289, 298, 306 Sex Determination, 226, 298 Shock, 299, 305 Side effect, 215, 250, 255, 299, 304 Sigmoid, 55, 84, 88, 195, 299 Sigmoid Colon, 84, 299 Signal Transduction, 25, 299 Signs and Symptoms, 6, 296, 299, 306 Silicon, 145, 185, 299 Silicon Dioxide, 299 Skeletal, 15, 259, 262, 283, 299 Skeleton, 185, 202, 268, 277, 292, 299 Skull, 299, 303 Sleep apnea, 164, 187, 299 Small intestine, 3, 9, 258, 265, 274, 275, 276, 277, 299 Smoke Inhalation Injury, 268, 299 Smooth muscle, 251, 257, 261, 274, 299 Social Environment, 294, 299 Social Security, 295, 300 Sodium, 264, 300 Soft tissue, 11, 23, 159, 162, 163, 173, 184, 186, 255, 270, 299, 300 Solvent, 271, 300 Sound wave, 261, 300 Spastic, 139, 300 Spasticity, 300 Specialist, 236, 238, 264, 300 Species, 19, 22, 27, 250, 262, 266, 274, 282, 294, 300, 301, 302, 305, 308 Spectrum, 300, 302 Sperm, 17, 300 Spermatic, 82, 106, 151, 156, 158, 161, 162, 174, 179, 180, 186, 187, 202, 300 Sphincter, 4, 5, 9, 13, 28, 100, 139, 153, 154, 165, 179, 201, 213, 234, 235, 236, 270, 278, 279, 300 Spina bifida, 211, 300 Spinal cord, 256, 258, 259, 265, 266, 270, 281, 284, 287, 288, 300, 303 Spleen, 65, 207, 246, 279, 280, 300 Splenectomy, 6, 300 Sporadic, 297, 300 Sprains and Strains, 279, 300 Stabilization, 4, 61, 159, 184, 301 Staging, 298, 301 Stasis, 5, 301 Steel, 185, 259, 301 Stenosis, 129, 301 Stent, 286, 301 Sterility, 276, 301

322 Hernia

Sterilization, 10, 301 Steroid, 12, 262, 287, 297, 301 Stimulant, 256, 274, 301 Stimulus, 16, 265, 301, 304 Stoma, 9, 263, 286, 301 Stool, 260, 275, 278, 301 Strangulation, 6, 9, 109, 151, 174, 197, 200, 301 Streptococcal, 114, 301 Streptococcus, 48, 301 Stress, 27, 144, 157, 164, 183, 187, 190, 222, 283, 286, 301 Stricture, 21, 301 Stroke, 135, 220, 257, 301 Stromal, 165, 166, 266, 301, 302 Stromal Cells, 165, 302 Subacute, 276, 302 Subarachnoid, 73, 272, 302 Subclinical, 276, 298, 302 Subcutaneous, 202, 270, 287, 302 Subspecies, 300, 302 Substrate, 166, 302 Suction, 54, 302 Sulbactam, 54, 210, 302 Sulfur, 268, 282, 302 Support group, 203, 237, 302 Suppository, 96, 291, 302 Suppression, 9, 71, 302 Surfactant, 16, 30, 58, 104, 302 Surgical Mesh, 142, 143, 153, 160, 163, 168, 169, 171, 172, 175, 177, 178, 186, 211, 302 Survival Rate, 23, 302 Sympathectomy, 140, 170, 302 Sympathetic Nervous System, 302 Symphysis, 141, 171, 258, 293, 303 Symptomatic, 5, 6, 20, 105, 180, 202, 287, 303 Synaptic, 284, 299, 303 Synchrony, 14, 303 Syncope, 66, 111, 303 Syrinx, 19, 303 Systemic, 252, 255, 266, 276, 277, 294, 298, 303 Systolic, 275, 303 T Tamponade, 60, 303 Telangiectasia, 226, 303 Temporal, 12, 19, 30, 303 Tendon, 202, 270, 300, 303 Testicle, 198, 272, 303, 307 Testicular, 62, 230, 262, 303 Testis, 96, 102, 108, 198, 300, 303

Thalamic, 253, 303 Thalamic Diseases, 253, 303 Therapeutics, 26, 71, 72, 216, 303 Thigh, 81, 155, 268, 272, 303 Thoracic, 6, 19, 24, 40, 45, 49, 54, 70, 86, 91, 102, 107, 127, 206, 207, 254, 263, 290, 303, 308 Thoracotomy, 202, 303 Thorax, 4, 83, 145, 249, 279, 304 Threshold, 21, 274, 304 Thrombin, 268, 290, 304 Thrombosis, 36, 74, 293, 301, 304 Thrombus, 262, 276, 283, 290, 304 Thyroid, 58, 304, 306 Tissue Banks, 173, 304 Tissue Culture, 17, 29, 166, 304 Tolazoline, 121, 304 Tomography, 261, 298, 304 Tone, 27, 267, 300, 304 Tonus, 304 Torsion, 31, 79, 198, 276, 304 Toxic, iv, 262, 266, 284, 299, 304 Toxicity, 265, 304 Toxicology, 222, 304 Toxins, 252, 271, 276, 298, 304 Trace element, 284, 299, 304 Trachea, 16, 256, 278, 289, 301, 304 Traction, 259, 305 Transcriptase, 297, 305 Transcription Factors, 22, 305 Transduction, 16, 299, 305 Transfection, 255, 271, 305 Translational, 158, 305 Translocation, 120, 305 Transplantation, 16, 75, 77, 83, 85, 259, 305 Transverse Colon, 207, 305 Trauma, 6, 16, 65, 81, 85, 121, 127, 161, 173, 198, 199, 203, 254, 267, 272, 287, 303, 305, 308 Treatment Failure, 7, 305 Trigeminal, 167, 280, 305 Trigeminal Nerve, 167, 305 Triglyceride, 15, 305 Trusses, 146, 305 Tryptophan, 260, 298, 305 Tubal ligation, 114, 305 Tuberous Sclerosis, 226, 305 Tumor Necrosis Factor, 112, 306 Tyrosine, 26, 264, 306 U Ulcer, 23, 65, 206, 265, 285, 306, 307 Ulceration, 23, 65, 306

Index 323

Ultrasonography, 9, 40, 53, 68, 95, 110, 306 Umbilical Arteries, 306 Umbilical Cord, 181, 306 Umbilicus, 64, 200, 306 Unconscious, 251, 275, 306 Urachal Cyst, 112, 306 Urachus, 306 Uraemia, 287, 306 Urease, 284, 306 Ureter, 77, 277, 306 Urethra, 293, 306, 307 Urinary, 10, 70, 83, 114, 126, 263, 271, 275, 293, 297, 306, 307 Urinary Fistula, 126, 306 Urinary Retention, 70, 306 Urinary tract, 306, 307 Urinate, 233, 306, 307, 308 Urine, 255, 264, 273, 275, 306, 307 Urogenital, 271, 307 Urography, 112, 307 Urology, 40, 59, 75, 97, 98, 100, 104, 112, 114, 151, 174, 198, 233, 307 Uterus, 67, 256, 258, 262, 266, 275, 281, 286, 292, 303, 305, 307 V Vaccines, 307, 308 Vagina, 52, 258, 281, 303, 307 Vaginal, 113, 173, 302, 307 Varicocele, 17, 140, 307 Varicose, 191, 307 Varicose vein, 191, 307 Varix, 107, 307 Vas Deferens, 67, 144, 157, 198, 300, 307 Vasculitis, 287, 307 Vasoconstriction, 120, 266, 307 Vasodilator, 121, 256, 264, 274, 304, 307 Vector, 305, 307

Vein, 44, 251, 277, 285, 291, 297, 306, 307 Venous, 293, 307 Venter, 307 Ventilation, 27, 29, 72, 73, 126, 307 Ventilator, 12, 280, 296, 307 Ventricle, 294, 303, 308 Ventricular, 33, 303, 308 Venules, 255, 257, 282, 308 Vertebrae, 276, 300, 308 Vertebral, 254, 300, 308 Veterinary Medicine, 120, 221, 308 Viral, 269, 297, 305, 308 Virus, 167, 254, 297, 305, 308 Visceral, 29, 66, 202, 289, 308 Vitreous, 296, 308 Vitreous Body, 296, 308 Vitro, 166, 273, 308 Vivo, 15, 23, 24, 25, 165, 166, 308 Vocal cord, 108, 308 Void, 153, 163, 175, 177, 178, 308 Volvulus, 43, 65, 72, 197, 308 W Watchful waiting, 106, 308 Weight Gain, 15, 182, 308 Wheezing, 235, 308 Windpipe, 289, 304, 308 Womb, 307, 308 Wound Healing, 10, 14, 100, 123, 159, 184, 196, 259, 280, 308 Wound Infection, 54, 210, 308 X Xenograft, 252, 308 X-ray, 5, 108, 234, 247, 261, 269, 270, 277, 285, 294, 298, 309 Y Yeasts, 289, 309

324 Hernia

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