São Paulo medical journal = Revista paulista de medicina
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Case Reports
Intestinal obstruction induced by a giant incarcerated Spigelian hernia: case report and review of the literature.
Spigelian hernia is an uncommon spontaneous lateral ventral hernia with an incarceration ratio of around 20%. However, complications such as intestinal obstruction are extremely rare. We report on a case of giant incarcerated Spigelian hernia with a clinical condition of complete intestinal obstruction that was treated using prosthetic polypropylene mesh. ⋯ A 72-year-old woman was admitted to the emergency department complaining of diffuse abdominal pain. Abdominal examination revealed a firm 10 x 10 cm tender mass in the lower left quadrant, without surrounding cellulite or tenderness. Plain abdominal radiographs displayed the formation of levels, thus indicating the existence of intestinal obstruction. An abdominal computed tomography scan clearly showed a fluid and air-filled mass in the soft tissue area of the lower left-side abdominal wall. Spigelian incarcerated hernia was diagnosed and the patient underwent emergency surgical repair by means of local incision. The large defect in the abdominal wall was closed up as successive anatomical layers, and a prosthetic polypropylene mesh was set into the lateral aspect of the rectus sheath. The postoperative course was uneventful and the patient was discharged on the seventh postoperative day.
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Short stature is defined as a height of more than two standard deviations below the average for a given age and sex in a reference population. The objective was to describe follow-up conducted among short-stature children and adolescents. ⋯ Growth rate assessment must form part of the investigation and follow-up of short-stature cases. However, its utilization and validity should form part of an overall view of each patient.
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Standardization of normal joint mobility criteria is complex, especially for preschool children, for whom differentiation from hypermobility (JH) is even more difficult. This study aimed to investigate joint mobility of the fifth finger, wrist, elbow, knee and trunk among preschool children, estimate the incidence of JH and evaluate the effect of gender and age and the applicability of standard criteria for identifying JH among preschool children. ⋯ JH is a common condition among preschool children and currently available methods are inadequate. New parameters and criteria should be developed for identifying JH among these children.
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Editorial Comment
Dipyrone and blood dyscrasia revisited: "non-evidence based medicine".