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22 - Inguinal and umbilical hernias
- from Part IV - Abdomen
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- By Emma J. Parkinson, Department of Paediatric Surgery, Institute of Child Health, London, UK, Agostino Pierro, Department of Paediatric Surgery, Institute of Child Health, London, UK
- Edited by Mark D. Stringer, Keith T. Oldham, Pierre D. E. Mouriquand
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- Book:
- Pediatric Surgery and Urology
- Published online:
- 08 January 2010
- Print publication:
- 09 November 2006, pp 286-295
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Summary
Inguinal hernia
The patent processus vaginalis is the common element in the pathogenesis of both congenital indirect inguinal hernia and congenital hydrocele. A wide patent processus creates a hernia by permitting the passage of intra-abdominal organs into the hernia sac, a hydrocele has a narrower processus permitting the passage of intraperitoneal fluid only. An inguinal hernia commonly presents as a reducible groin mass emerging from the external inguinal ring, lateral to the pubic tubercle, and may extend into the scrotum.
Congenital indirect inguinal hernias are one of the most common surgical conditions in infancy with a peak incidence in the first three months of life, occurring in approximately 3.5 to 5% of full-term neonates. In premature infants the incidence increases further, up to approximately 30%.
Boys have an increased incidence (male to female ratio between 8:1 and 12:1). In both sexes the incidence of right-sided inguinal hernia is higher than left (right 64%, left 29%, bilateral 7%). Consequently, patients presenting initially with a left-sided hernia have a higher probability of developing a metachronous hernia.
Specific abnormalities predispose to the development of inguinal hernia early in life. Prematurity is the most important risk factor (Table 22.1). These conditions represent part of a whole spectrum of incomplete obliteration of the processus vaginalis which leads to the potential development of both hydroceles and inguinal hernias.
Historical aspects
There is evidence from 1552 BC that the Egyptians described inguinal hernias controlled by external pressure.
39 - Nutrition in the neonatal surgical patient
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- By Agostino Pierro, Department of Paediatric Surgery, The Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, University College London, London, UK, Simon Eaton, Department of Paediatric Surgery, The Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, University College London, London, UK
- Patti J. Thureen, University of Colorado at Denver and Health Sciences Center
- Edited by William W. Hay, University of Colorado at Denver and Health Sciences Center
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- Book:
- Neonatal Nutrition and Metabolism
- Published online:
- 10 December 2009
- Print publication:
- 04 May 2006, pp 569-585
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Summary
Introduction
The newborn infant is in a “critical epoch” of development not only for the organism as a whole but also for the individual organs and most significantly for the brain. Adequate nutrition in the neonatal period is necessary to avoid the adverse effects of malnutrition on morbidity and mortality and to minimise the future menace of stunted mental and physical development.
The survival rate of newborn infants affected by isolated congenital gastrointestinal abnormalities has improved considerably over the past 20 years and is now in excess of 90% in most pediatric surgical centers. The introduction of parenteral nutrition and advancement in nutritional management are certainly among the main factors responsible for this improvement.
Historical background
Parenteral nutrition stepped forward from numerous historical anecdotes in the 1930s with the first successful infusion of protein hydrolysates in humans, followed by the first report of successful total parenteral nutrition in an infant in 1944, and given a huge boost by the first placement of a catheter in the superior vena cava to deliver nutrients for prolonged periods. Using this system, Dudrick and Wilmore showed that adequate growth and development could be achieved in beagle puppies and in a surgical infant. Following these initial reports Filler and co-authors reported the first series of surgical neonates with gastrointestinal abnormalities treated with long-term total parenteral nutrition.