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The Rupture?
Topic Started: Jun 7 2006, 07:31 AM (108 Views)
George K
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Finally
(for Bachophile)

The Rupture

and a temporary solution

Posted Image
A guide to GKSR: Click

"Now look here, you Baltic gas passer... "
- Mik, 6/14/08


Nothing is as effective as homeopathy.

I'd rather listen to an hour of Abba than an hour of The Beatles.
- Klaus, 4/29/18
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bachophile
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HOLY CARP!!!
for george

from JAMA

Watchful waiting vs repair of inguinal hernia in minimally symptomatic men: a randomized clinical trial.

Fitzgibbons RJ Jr, Giobbie-Hurder A, Gibbs JO, Dunlop DD, Reda DJ, McCarthy M Jr, Neumayer LA, Barkun JS, Hoehn JL, Murphy JT, Sarosi GA Jr, Syme WC, Thompson JS, Wang J, Jonasson O.

Department of Surgery, Creighton University, Omaha, Neb, USA.

CONTEXT: Many men with inguinal hernia have minimal symptoms. Whether deferring surgical repair is a safe and acceptable option has not been assessed. OBJECTIVE: To compare pain and the physical component score (PCS) of the Short Form-36 Version 2 survey at 2 years in men with minimally symptomatic inguinal hernias treated with watchful waiting or surgical repair. DESIGN, SETTING, AND PARTICIPANTS: Randomized trial conducted January 1, 1999, through December 31, 2004, at 5 North American centers and enrolling 720 men (364 watchful waiting, 356 surgical repair) followed up for 2 to 4.5 years. INTERVENTIONS: Watchful-waiting patients were followed up at 6 months and annually and watched for hernia symptoms; repair patients received standard open tension-free repair and were followed up at 3 and 6 months and annually. MAIN OUTCOME MEASURES: Pain and discomfort interfering with usual activities at 2 years and change in PCS from baseline to 2 years. Secondary outcomes were complications, patient-reported pain, functional status, activity levels, and satisfaction with care. RESULTS: Primary intention-to-treat outcomes were similar at 2 years for watchful waiting vs surgical repair: pain limiting activities (5.1% vs 2.2%, respectively; P = .52); PCS (improvement over baseline, 0.29 points vs 0.13 points; P = .79). Twenty-three percent of patients assigned to watchful waiting crossed over to receive surgical repair (increase in hernia-related pain was the most common reason offered); 17% assigned to receive repair crossed over to watchful waiting. Self-reported pain in watchful-waiting patients crossing over improved after repair. Occurrence of postoperative hernia-related complications was similar in patients who received repair as assigned and in watchful-waiting patients who crossed over. One watchful-waiting patient (0.3%) experienced acute hernia incarceration without strangulation within 2 years; a second had acute incarceration with bowel obstruction at 4 years, with a frequency of 1.8/1000 patient-years inclusive of patients followed up for as long as 4.5 years. CONCLUSIONS: Watchful waiting is an acceptable option for men with minimally symptomatic inguinal hernias. Delaying surgical repair until symptoms increase is safe because acute hernia incarcerations occur rarely.Clinical Trials Registration ClinicalTrials.gov Identifier: NCT00263250.


bottom line:u dont need to operate every hernia. just the symptomatic ones.
"I don't know much about classical music. For years I thought the Goldberg Variations were something Mr. and Mrs. Goldberg did on their wedding night." Woody Allen
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JBryan
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I am the grey one
Apparently a mistranslation similar tom the islamic "72 virgins" is going to leave a lot of Evangelicals deeply disappointed as well as in a great deal of pain.
"Any man who would make an X rated movie should be forced to take his daughter to see it". - John Wayne


There is a line we cross when we go from "I will believe it when I see it" to "I will see it when I believe it".


Henry II: I marvel at you after all these years. Still like a democratic drawbridge: going down for everybody.

Eleanor: At my age there's not much traffic anymore.

From The Lion in Winter.
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George K
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Finally
I knew that....
A guide to GKSR: Click

"Now look here, you Baltic gas passer... "
- Mik, 6/14/08


Nothing is as effective as homeopathy.

I'd rather listen to an hour of Abba than an hour of The Beatles.
- Klaus, 4/29/18
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musicasacra
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HOLY CARP!!!
(those Victorian medical devices are funny!)

hmmm.

my only experience with hernias is that my grandfather had a "double strangulated hernia" that developed gangrene. he didn't mention he wasn't feeling well either.

i wonder what a double strangulated hernia looks like.
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bachophile
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HOLY CARP!!!
since u asked...

Posted Image

not sure about the "double"

in googling i found far worse but in deference to the forum choose not to be graphic.

a strangulated hernia is one in which the bowel is caught in the orifice of the hernia and is trapped, it cant be pushed in again.

the opening is usually narrow and this inpinges on the blood supply to the bowel protruding and "strangles" it by not allowing blood to reach it. the section then dies and turns black. not a pretty site. and often stinky.

isnt surgery fun????

"I don't know much about classical music. For years I thought the Goldberg Variations were something Mr. and Mrs. Goldberg did on their wedding night." Woody Allen
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musicasacra
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HOLY CARP!!!
bachophile
Jun 7 2006, 12:24 PM
since u asked...

Posted Image

not sure about the "double"

in googling i found far worse but in deference to the forum choose not to be graphic.

a strangulated hernia is one in which the bowel is caught in the orifice of the hernia and is trapped, it cant be pushed in again.

the opening is usually narrow and this inpinges on the blood supply to the bowel protruding and "strangles" it by not allowing blood to reach it. the section then dies and turns black. not a pretty site. and often stinky.

isnt surgery fun????

yikes! i can't believe my grandfather had that to the point of developing gangrene and never complained. those Swedes are tough and taciturn!
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