In Close Combat: Vice-Admiral Lord Horatio Nelson's Injuries in the Napoleonic Wars.

Born in Norfolk, England, on September 29, 1758, Horatio Nelson was the sixth of eleven children in a working-class family. With the help of his uncle, Maurice Suckling, a captain in the Royal Navy, Nelson began his naval career as a 13-year-old midshipman on the British battleship Raisonnable. His courage and leadership in the battle marked him for promotion, and he rose quickly from midshipman to admiral, serving in the West Indies, East Indies, North America, Europe, and even the Arctic. As his rank ascended, Nelson's consistent strategy was close engagement, an approach that led to success in combat but placed him in direct danger. Thus, Britain's greatest warrior was also her most famous patient: Nelson suffered more injuries and underwent more operations than any other flag officer in Royal Navy history. His career reached a climax off Cape Trafalgar, where he not only led the Royal Navy to victory over the combined French and Spanish fleets but also met his own death.

Pure tissue repairs: a timely and critical revival.

"The majority of hernias can be satisfactorily repaired by using the tissues at hand. The use of mesh prosthesis should be restricted to those few hernias in which tension or lack of good fascial structures prevents a secure primary repair. This group includes large direct inguinal hernias and incisional hernias in which the defect is too large to close primarily without undue tension. Most recurrent hernias, because of this factor are best repaired with mesh prosthesis". These words, penned in 1960 by Francis Usher have reconfirmed what had been a mantra of the Shouldice Hospital (Usher in 81:847-854, 1960). The Shouldice Hospital has specialized in the treatment of abdominal wall hernias since 1945. It has, since its beginning, insisted on the fact that a thorough knowledge of anatomy coupled with large volumes of surgical cases would lead to unparalleled expertise. It was Cicero who taught us that "Practice, not intelligence or dexterity, will win the day"! Since the seminal contribution of Bassini (1844-1924), there have been no less than 80 procedures imitating his inguinal herniorrhaphy and much more since the introduction of mesh and mesh devices (Iason in Hernia. The Blakiston Company, Philadelphia, pp 475-604, 1940). All have failed to some extent and it appears that the common denominator for these failures was the inability to understand the importance of entering the preperitoneal space. Only Shouldice and McVay (Lotheissen, Narath) realized the shortcoming and have continued to thrive as a successful procedure. Entering the preperitoneal space eliminates any temptation to plicate the posterior inguinal wall, a layer normally deficient in direct inguinal hernias, but it also allows the identification of muscle layers rectus, transversus and internal oblique muscles which will go to reconstruct the posterior inguinal wall, without tension as reported by Schumpelick (Junge in 7(1):17-20, 2003).

Hernia de Garengeot. A propósito de un caso / De Garengeot´s hernia. Apropos of a case

RESUMEN El epónimo hernia De Garengeot queda reservado para describir la presencia del apéndice cecal dentro de un saco herniario crural. Es infrecuente el hallazgo del apéndice dentro del canal femoral, situación que se presenta en el 0.9 % de las hernias femorales. La presencia de apendicitis dentro del canal femoral es una rareza, representando del 0.13 a 0.8% de todos los casos de apendicitis aguda. Se presenta un caso, se describe el cuadro clínico y el tratamiento quirúrgico (AU).

ABSTRACT The eponym De Garengeot´s hernia is reserved to describe the presence of the cecal appendix inside a crural hernia sac. It is infrequent to find the appendix inside the femoral canal, location presented in 0.9 % of femoral hernias. The presence of appendicitis inside the femoral canal is a rarity representing from 0.13 to 0.8 % of all the cases of acute appendicitis. A case is presented, and the clinical characteristics and the surgical treatment are described (AU).

Hernia de Garengeot. A propósito de un caso / De Garengeot´s hernia. Apropos of a case

RESUMEN El epónimo hernia De Garengeot queda reservado para describir la presencia del apéndice cecal dentro de un saco herniario crural. Es infrecuente el hallazgo del apéndice dentro del canal femoral, situación que se presenta en el 0.9 % de las hernias femorales. La presencia de apendicitis dentro del canal femoral es una rareza, representando del 0.13 a 0.8% de todos los casos de apendicitis aguda. Se presenta un caso, se describe el cuadro clínico y el tratamiento quirúrgico (AU).

ABSTRACT The eponym De Garengeot´s hernia is reserved to describe the presence of the cecal appendix inside a crural hernia sac. It is infrequent to find the appendix inside the femoral canal, location presented in 0.9 % of femoral hernias. The presence of appendicitis inside the femoral canal is a rarity representing from 0.13 to 0.8 % of all the cases of acute appendicitis. A case is presented, and the clinical characteristics and the surgical treatment are described (AU).

Perícias, acidentes e hérnias no contexto do direito à saúde, Colômbia 1915-1946 / Expertise, accidents and hernias in the context of the right to health, Colombia 1915-1946

Para a maioria dos médicos, a apreciação da incapacidade em casos de acidentes de trabalho ou doenças profissionais era um assunto bastante relativo e juízo clínico, subjetivo e pouco satisfatório em questões jurídicas. No esquema da lei de acidentes de trabalho, eles tinham a função de julgar o nexo de causalidade entre o acidente e a doença, ao mesmo tempo que indicar o tipo de compensação econômica que devia receber o trabalhador. Para isto, deviam ir além do conhecimento científico e compreender a multiplicidade de fatores sociais que envolvem o infortúnio no mundo do trabalho. Neste artigo, analisam-se fontes colombianas da primeira metade do século XX, sobre questões como fisiologia do trabalho, fadiga, risco profissional, acidentes de trabalho, doenças profissionais, etc. Pretende-se avançar na compreensão da maneira como o campo de saber médico foi configurando uma espécie de deontologia pericial nos casos de acidente de trabalho, porém, se concentra nas hérnias, um dos estigmas típicos do mundo do trabalho (AU)

For most physicians, the assessment of disability in cases of work accident or occupational disease is very relative matter, and clinical judgments are subjective and unsatisfactory in legal settings. Work accident legislation gives them the task of deciding on any causal links between accident and disease and indicating any economic compensation that should be awarded. They must therefore reach beyond their scientific knowledge to understand the multitude of social factors that underlie these problems in the world of work. In this article, we analyze Colombian sources from the first half of the 20th century on the physiology of labor, fatigue, professional risk, work accidents, occupational diseases, among other issues. The aim is to advance understanding of how the field of medical knowledge established an ethical approach for experts in cases of occupational accidents, focusing on hernias, typical misfortunes of the world of work (AU)

Investigación histórica de las hernias laterales de la pared abdominal / Historical analysis of the lateral abdominal wall hernias

Objective: To analyze the history of lateral abdominal wall hernias. Method: Review of the literature. Critical analysis of articles, books and monographs published, using key words: "ventral, lateral or semilunar abdominal wall hernia". Results: Undocumented contributions, such as Mancke, Molliére, Reynier, Ferrand or Thèvenot, among others are discovered. Casseri was the first surgeon to illustrate the semilunar line, before Spiegel. Mancke was the first surgeon to use the term lateral ventral hernia. Molliére was the first surgeon to use the term semilunar hernia (not Klinkosch). Thévenot was the first surgeon to use the term Spiegel hernia. Conclusion: The story of the lateral hernias has errors and omissions of important authors. 1) semilunar line was known and illustrated first by Casseri, so we should call Spiegel-Casseri semilunar line; 2) Klinkosch was not the first to use the name of semilunar hernia, but Molliere, who defined them as a different group of ventral; 3) Mancke was first named as the lateral hernias, and Ferrand side who made the first thesis under that title, and 4) the contributions of Reignier and Thévenot, not mentioned in any treatise on surgery are discovered.

Objetivo: Analizar la historia de la hernia lateral de la pared abdominal. Método: Revisión de la literatura. Análisis crítico de los artículos, tesis, libros y monografías publicadas, utilizando como palabras clave: "hernia ventral, lateral o semilunar". Resultados: Se descubren aportaciones no documentadas, como las de Mancke, Molliére, Reynier, Ferrand o Thévenot, entre otros. Casseri fue el primer cirujano en ilustrar la línea semilunar, antes que Spiegel. Mancke, el primero que utilizó el nombre de hernia lateral del abdomen. Molliére fue el primero que usó el término hernia semilunar (no Klinkosch), y Thévenot el primero que usó el término hernia de Spiegel. Conclusión: La historia de las hernias laterales presenta errores y omisiones de autores importantes: 1) la línea semilunar fue conocida e ilustrada primero por Casseri, por lo que deberíamos llamarla línea semilunar de Spiegel-Casseri; 2) Klinkosch no fue el primero en utilizar el nombre de hernia semilunar, sino Molliére, quien las definió como un grupo diferente de las hernias ventrales; 3) Mancke fue el primero que las nombró como hernias laterales y Ferrand quien realizó la primera tesis bajo ese título, y 4) se descubren las aportaciones de Reignier y Thévenot, no mencionadas en ningún tratado de cirugía.

Cirugía de la hernia en España: Siglo XVIII / No disponible

No disponible

Franz Kaspar Hesselbach (1759--1816): anatomist and surgeon.

Although the term Hesselbach's triangle is used in everyday general surgical practice, little is written and known regarding the life of the early surgical pioneer for whom it is named. The present paper reviews the life of the German Franz Kaspar Hesselbach (1759--1816) and his contributions to the anatomical sciences and practice of surgery.

Archaic terms and dogmas impeding care of abdominal and pelvic herniation.

During the past 5000 years, ancient nomenclature and dogmas regarding the etiology of protrusions have accumulated. Whereas, in the abdomen, the Latin "hernia" supplanted Greek, it, based on content, persists in the pelvis as cystocele, rectocele, etc. Russell (Lancet 1:1519-1523, 1902) championed the congenital saccular theory of herniae, denying they could ever be acquired pathologically. Barring technical error, removal of the sac would cure. Despite dissent in the 1920s by Harrison, Keith, and Andrews, Russell's concepts held late into the twentieth century. We now know that pathology - systemic connective tissue disease - plays an important role in adult herniation. Tensionless prosthetic repair is usually required since the healing of damaged musculo-aponeurotic structures in abdomen or pelvis is impaired. Laparoscopists have declared sliding extraperitoneal prolapse of sacless kidney, ureter, bladder, and fat pad to be herniae. Similar vaginal protrusions should be denoted likewise. It is time gynecologists and herniologists join in the effort to develop antidotes for combating this pernicious co-morbidity which has been shown also to cause aneurysms, diverticulosis coli, skin changes, and emphysema. Prophylaxis should include exercise and going without cigarettes.

The history of anatomy and surgery of the preperitoneal space.

Preperitoneal (properitoneal) space is the space between the peritoneum and transversalis fascia. Bogros (1786-1825) described a triangular space in the iliac region between the iliac fascia, transversalis fascia, and parietal peritoneum. In the modern concept, this space lies between the peritoneum and posterior lamina of the transversalis fascia. In 1858, Retzius described the homonymous space, situated anterior and lateral to the urinary bladder (prevesical space). In 1975, Fowler reported that the preperitoneal fascia of the groin is distinct from the transversalis fascia. Preperitoneal herniorrhaphy may be subdivided into 2 approaches: transperitoneal and inguinal. We present herein the evolution of approaches to the preperitoneal space from use of the transperitoneal (or posterior) to use of the anterior preperitoneal and posterior preperitoneal approaches. As anatomic knowledge has increased, the evolution of laparoscopic surgery has paralleled that of open procedures.