Hernia repair refers to a surgical operation for the correction of a hernia—a bulging of internal organs or tissues through the wall that contains it. It can be of two different types: herniorrhaphy; this operation may be performed to correct hernias of the abdomen, diaphragm, brain, or at the site of a previous operation. Hernia repair is performed as an ambulatory procedure; the first differentiating factor in hernia repair is whether the surgery is done open, or laparoscopically. Open hernia repair is. Laparoscopic hernia repair is when minimally invasive cameras and equipment are used and the hernia is repaired with only small incisions adjacent to the hernia; these techniques are similar to the techniques used in laparoscopic gallbladder surgery. An operation in which the hernia sac is removed without any repair of the inguinal canal is described as a herniotomy; when herniotomy is combined with a reinforced repair of the posterior inguinal canal wall with autogenous or heterogeneous material such as prolene mesh, it is termed hernioplasty as opposed to herniorrhaphy, in which no autogenous or heterogeneous material is used for reinforcement.
European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. American Hernia Society Melbourne Hernia Clinic Surgery Methods, Inguinal Hernia, Comparison
Pathology is the study of the causes and effects of disease or injury. The word pathology refers to the study of disease in general, incorporating a wide range of bioscience research fields and medical practices. However, when used in the context of modern medical treatment, the term is used in a more narrow fashion to refer to processes and tests which fall within the contemporary medical field of "general pathology," an area which includes a number of distinct but inter-related medical specialties that diagnose disease through analysis of tissue and body fluid samples. Idiomatically, "a pathology" may refer to the predicted or actual progression of particular diseases, the affix path is sometimes used to indicate a state of disease in cases of both physical ailment and psychological conditions. A physician practicing pathology is called a pathologist; as a field of general inquiry and research, pathology addresses four components of disease: cause, mechanisms of development, structural alterations of cells, the consequences of changes.
In common medical practice, general pathology is concerned with analyzing known clinical abnormalities that are markers or precursors for both infectious and non-infectious disease and is conducted by experts in one of two major specialties, anatomical pathology and clinical pathology. Further divisions in specialty exist on the basis of the involved sample types and physiological systems, as well as on the basis of the focus of the examination. Pathology is a significant field in medical research; the study of pathology, including the detailed examination of the body, including dissection and inquiry into specific maladies, dates back to antiquity. Rudimentary understanding of many conditions was present in most early societies and is attested to in the records of the earliest historical societies, including those of the Middle East and China. By the Hellenic period of ancient Greece, a concerted causal study of disease was underway, with many notable early physicians having developed methods of diagnosis and prognosis for a number of diseases.
The medical practices of the Romans and those of the Byzantines continued from these Greek roots, but, as with many areas of scientific inquiry, growth in understanding of medicine stagnated some after the Classical Era, but continued to develop throughout numerous cultures. Notably, many advances were made in the medieval era of Islam, during which numerous texts of complex pathologies were developed based on the Greek tradition. So, growth in complex understanding of disease languished until knowledge and experimentation again began to proliferate in the Renaissance and Baroque eras, following the resurgence of the empirical method at new centers of scholarship. By the 17th century, the study of microscopy was underway and examination of tissues had led British Royal Society member Robert Hooke to coin the word "cell", setting the stage for germ theory. Modern pathology began to develop as a distinct field of inquiry during the 19th Century through natural philosophers and physicians that studied disease and the informal study of what they termed “pathological anatomy” or “morbid anatomy”.
However, pathology as a formal area of specialty was not developed until the late 19th and early 20th centuries, with the advent of detailed study of microbiology. In the 19th century, physicians had begun to understand that disease-causing pathogens, or "germs" existed and were capable of reproduction and multiplication, replacing earlier beliefs in humors or spiritual agents, that had dominated for much of the previous 1,500 years in European medicine. With the new understanding of causative agents, physicians began to compare the characteristics of one germ’s symptoms as they developed within an affected individual to another germ’s characteristics and symptoms; this realization led to the foundational understanding that diseases are able to replicate themselves, that they can have many profound and varied effects on the human host. To determine causes of diseases, medical experts used the most common and accepted assumptions or symptoms of their times, a general principal of approach that persists into modern medicine.
Modern medicine was advanced by further developments of the microscope to analyze tissues, to which Rudolf Virchow gave a significant contribution, leading to a slew of research developments. By the late 1920s to early 1930s pathology was deemed a medical specialty. Combined with developments in the understanding of general physiology, by the beginning of the 20th century, the study of pathology had begun to split into a number of rarefied fields and resulting in the development of large number of modern specialties within pathology and related disciplines of diagnostic medicine; the term pathology comes from the Ancient Greek roots of pathos, meaning "experience" or "suffering" and -logia, "study of". The modern practice of pathology is divided into a number of subdisciplines within the discrete but interconnected aims of biological research and medical practice. Biomedical research into disease incorporates the
Massage is the manipulation of soft tissues in the body. Massage techniques are applied with hands, elbows, forearms, feet, or a device; the purpose of massage is for the treatment of body stress or pain. A person, professionally trained to give massages was traditionally known as a masseur or a masseuse, but those titles are outmoded, carry some negative connotations. In the United States, the title massage therapist has been recognized as a business norm for those who have been professionally trained to give massages. In professional settings, clients are treated while lying on a massage table, sitting in a massage chair, or lying on a mat on the floor. In amateur settings, a general purpose surface like a bed or the floor is more common. Aquatic massage and bodywork is performed with recipients submersed or floating in a warm-water therapy pool; the word comes from the French massage "friction of kneading", which, in turn, comes from the Arabic word مَسَّ massa meaning "to touch, feel". Others claim an origin from the Portuguese amassar "knead", from the Latin massa meaning "mass, dough", from the Greek verb μάσσω "to handle, touch, to work with the hands, to knead dough".
In distinction the ancient Greek word for massage was anatripsis, the Latin was frictio. Archaeological evidence of massage has been found in many ancient civilizations including China, Japan, Egypt, Rome and Mesopotamia. BC 2330: The Tomb of Akmanthor in Saqqara, Egypt depicts two men having work done on their feet and hands massage. BC 722-481: Huangdi Neijing is composed during the Chinese Spring and Autumn period; the Nei-jing is a compilation of medical knowledge known up to that date, is the foundation of Traditional Chinese Medicine. Massage is referred to in 30 different chapters of the Nei Jing, it specifies the use of different massage techniques and how they should be used in the treatment of specific ailments, injuries. Known as "The Yellow Emperor's Inner Canon", the text refers to previous medical knowledge from the time of the Yellow Emperor, misleading some into believing the text itself was written during the time of the Yellow Emperor. BC 762 "In the Iliad and the Odyssey the massage with oils and aromatic substances is mentioned as a means to relax the tired limbs of warriors and a way to help the treatment of wounds,"BC 700 Bian Que, the earliest known Chinese physician uses massage in medical practice.
BC 500 Jīvaka Komarabhācca known as Shivago Komarpaj, the founder of Traditional Thai massage and Thai medicine. According to the Pāli Buddhist Canon, Jivaka was Shakyamuni Buddha's physician, he codified a healing system that combines acupressure and assisted yoga postures. Traditional Thai massage is based on a combination of Indian and Chinese traditions of medicine. Jivaka is known today as "Father Doctor" in Thailand. BC 493: A possible biblical reference documents daily "treatments" with oil of myrrh as a part of the beauty regimen of the wives of Xerxes. BC 460: Hippocrates wrote "The physician must be experienced in many things, but assuredly in rubbing". BC 300 Charaka Samhita believed to be the oldest of the three ancient treatises of Ayurvedic medicine, including massage. Sanskrit records indicate that massage had been practiced in India long before the beginning of recorded history. AD 581: Dr Sun Si Miao introduces ten new massage techniques and systematized the treatment of childhood diseases using massage therapy.
AD 581: China establishes a department of massage therapy within the Office of Imperial Physicians. Middle-Ages: Medical knowledge, including that of massage, made its way from Rome to Persia in the Middle Ages. Many of Galen's manuscripts, for instance, were collected and translated by Hunayn ibn Ishaq in the 9th century. In the 11th century copies were translated back into Latin, again in the 15th and 16th centuries, when they helped enlighten European scholars as to the achievements of the Ancient Greeks; this renewal of the Galenic tradition during the Renaissance played a important part in the rise of modern science. One of the greatest Persian medics was Avicenna known as Ibn Sina, who lived from 980AD to 1037AD, his works included a comprehensive collection and systematisation of the fragmentary and unorganised Greco-Roman medical literature, translated Arabic by that time, augmented by notes from his own experiences. One of his books, Al-Qānūn fī aṭ-Ṭibb has been called the most famous single book in the history of medicine in both East and West.
Avicenna excelled in the logical assessment of conditions and comparison of symptoms and took special note of analgesics and their proper use as well as other methods of relieving pain, including massage. AD 1150: Evidence of massage abortion, involving the application of pressure to the pregnant abdomen, can be found in one of the bas reliefs decorating the temple of Angkor Wat in Cambodia, it depicts a demon performing such an abortion upon a woman, sent to the underworld. This is the oldest known visual representation of abortion. AD 1776: Jean Joseph Marie Amiot, Pierre-Martial Cibot, French missionaries in China translate summaries of Huangdi Neijing, including a list of medical plants and elaborate massage techniques, into the French language, thereby introducing Europe to the developed Chinese system of medicine, medical-gymnastics, medical-massage. AD 1776 Pehr Henrik Ling, a Swedish physical therapist, teacher of medical-gymnastics is born. Ling has been erroneously credited for having invented "Classic Massage" aka "Swedish Massage", has be
In human anatomy, the thigh is the area between the hip and the knee. Anatomically, it is part of the lower limb; the single bone in the thigh is called the femur. This bone is thick and strong, forms a ball and socket joint at the hip, a modified hinge joint at the knee; the femur is the only bone in the thigh and serves for an attachment site for all muscles in the thigh. The head of the femur articulates with the acetabulum in the pelvic bone forming the hip joint, while the distal part of the femur articulates with the tibia and kneecap forming the knee. By most measures the femur is the strongest bone in the body; the femur is the longest bone in the body. The femur is categorised as a long bone and comprises a diaphysis, the shaft and two epiphysis or extremities that articulate with adjacent bones in the hip and knee. In cross-section, the thigh is divided up into three separate compartments, divided by fascia, each containing muscles; these compartments use the femur as an axis, are separated by tough connective tissue membranes.
Each of these compartments has its own blood and nerve supply, contains a different group of muscles. Medial fascial compartment of thigh, adductor Posterior fascial compartment of thigh, hamstring Anterior fascial compartment of thigh, extensionAnterior compartment muscles of the thigh include sartorius, the four muscles that comprise the quadriceps muscles- rectus femoris, vastus medialis, vastus intermedius and vastus lateralis. Posterior compartment muscles of the thigh are the hamstring muscles, which include semimembranosus and biceps femoris. Medial compartment muscles are pectineus, adductor magnus, adductor longus and adductor brevis, gracilis; because the major muscles of the thigh are the largest muscles of the body, resistance exercises of them stimulate blood flow more than any other localized activity. The arterial supply is by the obturator artery; the lymphatic drainage follows the arterial supply and drains to the lumbar lymphatic trunks on the corresponding side, which in turn drains to the cisterna chyli.
The deep venous system of the thigh consists of the femoral vein, the proximal part of the popliteal vein, various smaller vessels. The venae perfortantes connect the deep and the superficial system, which consists of the saphenous veins. Thigh weakness can result in a positive Gowers' sign on physical examination; the thigh meat of some animals such as chicken and cow is consumed as a food in many parts of the world
A nerve is an enclosed, cable-like bundle of nerve fibres called axons, in the peripheral nervous system. A nerve provides a common pathway for the electrochemical nerve impulses called action potentials that are transmitted along each of the axons to peripheral organs or, in the case of sensory nerves, from the periphery back to the central nervous system; each axon within the nerve is an extension of an individual neuron, along with other supportive cells such as Schwann cells that coat the axons in myelin. Within a nerve, each axon is surrounded by a layer of connective tissue called the endoneurium; the axons are bundled together into groups called fascicles, each fascicle is wrapped in a layer of connective tissue called the perineurium. The entire nerve is wrapped in a layer of connective tissue called the epineurium. In the central nervous system, the analogous structures are known as tracts; each nerve is covered on the outside by a dense sheath of the epineurium. Beneath this is a layer of flat cells, the perineurium, which forms a complete sleeve around a bundle of axons.
Perineurial septae subdivide it into several bundles of fibres. Surrounding each such fibre is the endoneurium; this forms an unbroken tube from the surface of the spinal cord to the level where the axon synapses with its muscle fibres, or ends in sensory receptors. The endoneurium consists of an inner sleeve of material called the glycocalyx and an outer, meshwork of collagen fibres. Nerves are bundled and travel along with blood vessels, since the neurons of a nerve have high energy requirements. Within the endoneurium, the individual nerve fibres are surrounded by a low-protein liquid called endoneurial fluid; this acts in a similar way to the cerebrospinal fluid in the central nervous system and constitutes a blood-nerve barrier similar to the blood-brain barrier. Molecules are thereby prevented from crossing the blood into the endoneurial fluid. During the development of nerve edema from nerve irritation, the amount of endoneurial fluid may increase at the site of irritation; this increase in fluid can be visualized using magnetic resonance neurography, thus MR neurography can identify nerve irritation and/or injury.
Nerves are categorized into three groups based on the direction that signals are conducted: Afferent nerves conduct signals from sensory neurons to the central nervous system, for example from the mechanoreceptors in skin. Efferent nerves conduct signals from the central nervous system along motor neurons to their target muscles and glands. Mixed nerves contain both afferent and efferent axons, thus conduct both incoming sensory information and outgoing muscle commands in the same bundle. Nerves can be categorized into two groups based on where they connect to the central nervous system: Spinal nerves innervate much of the body, connect through the vertebral column to the spinal cord and thus to the central nervous system, they are given letter-number designations according to the vertebra through which they connect to the spinal column. Cranial nerves innervate parts of the head, connect directly to the brain, they are assigned Roman numerals from 1 to 12, although cranial nerve zero is sometimes included.
In addition, cranial nerves have descriptive names. Specific terms are used to describe their actions. A nerve that supplies information to the brain from an area of the body, or controls an action of the body is said to "innervate" that section of the body or organ. Other terms relate to whether the nerve affects the same side or opposite side of the body, to the part of the brain that supplies it. Nerve growth ends in adolescence, but can be re-stimulated with a molecular mechanism known as "Notch signaling". If the axons of a neuron are damaged, as long as the cell body of the neuron is not damaged, the axons would regenerate and remake the synaptic connections with neurons with the help of guidepost cells; this is referred to as neuroregeneration. The nerve begins the process by destroying the nerve distal to the site of injury allowing Schwann cells, basal lamina, the neurilemma near the injury to begin producing a regeneration tube. Nerve growth factors are produced causing many nerve sprouts to bud.
When one of the growth processes finds the regeneration tube, it begins to grow towards its original destination guided the entire time by the regeneration tube. Nerve regeneration is slow and can take up to several months to complete. While this process does repair some nerves, there will still be some functional deficit as the repairs are not perfect. A nerve conveys information in the form of electrochemical impulses carried by the individual neurons that make up the nerve; these impulses are fast, with some myelinated neurons conducting at speeds up to 120 m/s. The impulses travel from one neuron to another by crossing a synapse, the message is converted from electrical to chemical and back to electrical. Nerves can be categorized into two groups based on function: An afferent nerve fiber conducts sensory information from a sensory neuron to the central nervous system, where the information is processed. Bundles of fibres or axons, in the peripheral nervous system are called nerves, bundles of afferent fibers are known as sensory nerves.
An efferent nerve fiber conducts signals from a motor neuron in the central nervous system to muscles. Bundles of these fibres are known as efferent nerves; the nervous system is the part of an animal that coordinates its actions by transmitting signals to and from different parts of its body. In vertebrates it consists of two main par
Nonsteroidal anti-inflammatory drug
Nonsteroidal anti-inflammatory drugs are a drug class that reduce pain, decrease fever, prevent blood clots and, in higher doses, decrease inflammation. Side effects depend on the specific drug, but include an increased risk of gastrointestinal ulcers and bleeds, heart attack and kidney disease; the term nonsteroidal distinguishes these drugs from steroids, which while having a similar eicosanoid-depressing, anti-inflammatory action, have a broad range of other effects. First used in 1960, the term served to distance these medications from steroids, which where stigmatised at the time due to the connotations with anabolic steroid abuse. NSAIDs work by inhibiting the activity of cyclooxygenase enzymes. In cells, these enzymes are involved in the synthesis of key biological mediators, namely prostaglandins which are involved in inflammation, thromboxanes which are involved in blood clotting. There are two types of NSAID available: COX-2 selective. Most NSAIDs are non-selective, inhibit the activity of both COX-1 and COX-2.
These NSAIDs, while reducing inflammation inhibit platelet aggregation and increase the risk of gastrointestinal ulcers/bleeds. COX-2 selective inhibitors have less gastrointestinal side effects, but promote thrombosis and increase the risk of heart attack; as a result, COX-2 selective inhibitors are contraindicated due to the high risk of undiagnosed vascular disease. These differential effects are due to the different roles and tissue localisations of each COX isoenzyme. By inhibiting physiological COX activity, all NSAIDs increase the risk of kidney disease and, through a related mechanism, heart attack; the most prominent NSAIDs are aspirin and naproxen, all available over the counter in most countries. Paracetamol is not considered an NSAID because it has only minor anti-inflammatory activity, it treats pain by blocking COX-2 in the central nervous system, but not much in the rest of the body. NSAIDs are used for the treatment of acute or chronic conditions where pain and inflammation are present.
NSAIDs are used for the symptomatic relief of the following conditions: Aspirin, the only NSAID able to irreversibly inhibit COX-1, is indicated for antithrombosis through inhibition of platelet aggregation. This is useful for the management of arterial thrombosis and prevention of adverse cardiovascular events like heart attacks. Aspirin inhibits platelet aggregation by inhibiting the action of thromboxane A2. In a more specific application, the reduction in prostaglandins is used to close a patent ductus arteriosus in neonates if it has not done so physiologically after 24 hours. NSAIDs are useful in the management of post-operative dental pain following invasive dental procedures such as dental extraction; when not contra-indicated they are favoured over the use of paracetamol alone due to the anti-inflammatory effect they provide. When used in combination with paracetamol the analgesic effect has been proven to be improved. There is weak evidence suggesting that taking pre-operative analgesia can reduce the length of post operative pain associated with placing orthodontic spacers under local anaesthetic.
Combination of NSAIDs with pregabalin as preemptive analgesia has shown promising results for decreasing post operative pain intensity. The effectiveness of NSAID's for treating non-cancer chronic pain and cancer-related pain in children and adolescents is not clear. There have not been sufficient numbers of high-quality randomized controlled trials conducted. NSAIDs may be used with caution by people with the following conditions: Irritable bowel syndrome Persons who are over age 50, who have a family history of GI problems Persons who have had past GI problems from NSAID useNSAIDs should be avoided by people with the following conditions: The widespread use of NSAIDs has meant that the adverse effects of these drugs have become common. Use of NSAIDs increases risk of a range of gastrointestinal problems, kidney disease and adverse cardiovascular events; as used for post-operative pain, there is evidence of increased risk of kidney complications. Their use following gastrointestinal surgery remains controversial, given mixed evidence of increased risk of leakage from any bowel anastomosis created.
An estimated 10–20% of NSAID patients experience dyspepsia. In the 1990s high doses of prescription NSAIDs were associated with serious upper gastrointestinal adverse events, including bleeding. Over the past decade, deaths associated with gastric bleeding have declined. NSAIDs, like all drugs, may interact with other medications. For example, concurrent use of NSAIDs and quinolones may increase the risk of quinolones' adverse central nervous system effects, including seizure. There is an argument over the benefits and risks of NSAIDs for treating chronic musculoskeletal pain; each drug has a benefit-risk profile and balancing the risk of no treatment with the competing potential risks of various therapies is the clinician's responsibility. If a COX-2 inhibitor is taken, a traditional NSAID should not be taken at the same time. In addition, people on daily aspirin therapy must be careful if they use other NSAIDs, as these may inhibit the cardioprotective effects of aspirin. Rofecoxib was shown to produce fewer gastrointestinal adverse drug reactions compared with naproxen.
This study, the VIGOR trial, raised the issue of the cardiovascular safety of the coxibs. A statistically significant increase in the incidence of myocardial infarctions was observed in patients on rofecoxib. Further data, from the APPROVe trial, s
Martin Bernhardt was a noted German neuropathologist. Bernhardt was a native of Potsdam, his family was Jewish. In 1867 he received his medical doctorate at the University of Berlin, where he was a student of Rudolf Virchow and Ludwig Traube. Subsequently, he became an assistant to Ernst Viktor von Leyden at the university clinic at Königsberg, afterwards worked at the Berlin-Charité under Carl Friedrich Otto Westphal. After military service in the Franco-Prussian War, he returned to Berlin as a specialist in neuropathology, in 1882 attained the title of "professor extraordinarius". Bernhardt published several treatises on neurological diseases and electrotherapy, in 1885 became editor-in-chief of the Centralblatt für die Medizinischen Wissenschaften. With Russian neuropathologist Vladimir Karlovich Roth, the eponymous "Bernhardt-Roth paraesthesia" is named; this condition is referred to as meralgia paraesthetica, is characterized by numbness or pain in the outer thigh, caused by injury to the lateral femoral cutaneous nerve.
Associated eponym: Bernhardt's formula: A formula used to calculate an adult's ideal weight in kilograms. Die Sensibilitätsverhältnisse der Haut. Erkrankungen der Peripherischen Nerven. Biography at the Jewish Encyclopedia Online Medical Dictionary Bernhardt-Roth paraesthesia @ Who Named It