Hernia

Hernia - inguinal; Inguinal hernia; Direct and indirect hernia; Rupture; Strangulation; Incarceration

A hernia is a sac formed by the lining of the abdominal cavity (peritoneum). The sac comes through a hole or weak area in the strong layer of the belly wall that surrounds the muscle. This layer is called the fascia. Which type of hernia you have depends on where it is:Femoral hernia is a bulge in the upper thigh, just below the groin. This...

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  • Hernia - Animation

    Hernia

    Animation

  • Hernia - Animation

    You're lifting a heavy box, when suddenly, you feel a strain in your stomach or groin. If you also feel a bulge there, you might have a hernia. The bump that you feel is a part of what's in your abdomen bulging out through a weak spot in the muscle or tissue that surrounds it. A hernia is kind of like pushing your finger against the side of a balloon. What type of hernia you have depends on where the bulge is located. A femoral hernia is a bulge in the upper part of your thigh. A hiatal hernia is located in the top part of your stomach. An umbilical hernia bulges around your belly button. Inguinal hernias are in the groin area. And incisional hernias usually form around a scar from a past surgery in your abdomen. You can get a hernia if you lift something that's too heavy, or strain too hard while coughing, urinating, or having a bowel movement. Sometimes babies are born with a hernia. That happens when the lining that is supposed to hold the abdominal organs doesn't totally close before birth. Some hernias don't cause any symptoms. You might live with a hernia for a while without even noticing that you have it. Or, you may see an actual bulge in your leg, stomach, or groin. Hernias can sometimes be painful, especially when you strain or lift something heavy. Your doctor should be able to locate the hernia during an exam. If your hernia is small and doesn't bother you, you may not need to do anything but keep in touch with your doctor to make sure it isn't growing. If the hernia is big or painful, your doctor may recommend surgery to plug the opening. The one big risk to having a hernia is that with some types the tissue can get caught inside the hole. This is called strangulation. It can be very dangerous, because blood is cut off to the part of the organ that's trapped. Eventually that tissue will die. If you have a strangulated hernia, you'll need to have emergency surgery. Surgery is the only way to reverse a hernia, although in young children umbilical hernias will often go away on their own. If you have a small hernia and decide not to have surgery, be on the lookout for any changes. Call the doctor right away if you have pain, nausea, vomiting, or a fever, or if your hernia turns red, purple, or another color. These could be signs of strangulation. To avoid a hernia in the first place, be careful when lifting heavy objects. Drink plenty of fluids and add fiber to your diet so you won't have to push too hard on the toilet. And see a urologist if you're straining while urinating.

  • Prepare for your child's hernia surgery - Animation

    Prepare for your child's hernia surgery

    Animation

  • Prepare for your child's hernia surgery - Animation

    Whenever your child is going in for surgery, it's a big deal for parents and for the child also. I'm Dr. Alan Greene and I'd like to discuss with you how to prepare your child, how to get ready for hernia surgery. The good news is that when the surgery is done you get instant results. Right away the problem's been fixed. And there are just a few steps to take to make the process go as smoothly as possible. Perhaps the first thing is preparing yourself because if you're feeling confident and good about the surgery, then everything will go much easier for you and for your child. And that means getting your questions answered beforehand. And in particular, the question I hear the most from parents is concern about the anesthesia. And that comes often from anesthesia risks that happened back when we were children. Anesthesia was much more dangerous than it is today. The problem was there weren't ways to monitor whether kids were getting enough oxygen to the brain or not. But since those monitors were developed about 20 years or so ago now, anesthesia has become incredibly safe - in fact, often safer than driving to the hospital. Now there other things that are important to do to prepare. First is to remember to take notice if your doctor has ordered any lab tests before the surgery. Perhaps blood tests, perhaps urine tests, maybe nothing was needed. But if it was, you want to make sure you've gotten it done before you end up going to the hospital. The second thing are instructions should've been given to you about when is the last time your child could eat or drink before heading to the hospital. Often it'll be midnight the night before, but whatever you were told be sure to take note of that and really don't cheat on this one. Nothing after what they say. And that leads to point number 3. Whatever medications that your child is taking, prescribed medicines, over-the-counter medicines, need to be taken into account. So, make sure you discuss with your physician, your anesthesiologist or the surgeon beforehand whatever medicines your child is taking and whether they should be taken or skipped after that deadline for food and drink. Next thing that's important, number 4, is to help your child select a favorite toy or stuffed animal, action figure to bring with them to the hospital. This little dog here or something that's comforting for them to have with them along the way. And it's a great idea before the whole thing depending on the age and temperament of your child to act out the whole scenario using their favorite toy. So, for instance, this little dog is not feeling well, hasn't been feeling well for awhile, has to take lots of medications, but the doctors are going to be able to fix it. Can't eat or drink anything after midnight - every step of it you go through. They're a little bit scared and they find out everything is fine and it worked out great and they get some ice cream afterwards and the problem is all gone. But to work it through with them so they get the story and it also helps you feel more prepared. I also suggest giving children something specific and fun to look forward to shortly after the surgery. It might be something as simple as a trip to the movies together or a trip to get ice cream but something that they can focus on. Take the focus a little bit off the surgery itself. Not a bad thing for you too. Then a couple of practical things. I do suggest that before going in you take off any jewelry that the child has, you bathe them, you get rid of even earrings that may stay in all the time or hair clips that may, you don't really want those at the hospital. And it's good to choose comfortable clothes when you go to the hospital, things that are easy on, easy off. It's not a fashion show. Although you may want some pictures of this cause it is a kind of historic moment. And lastly, if your child does develop any kind of fever or rash or cold beforehand, make sure to give them a call and let the folks know what's going on cause it may mean the surgery should be postponed. But the good news is that this kind of minor surgery today in children is extraordinarily safe and when it's done for the right child at the right time really helps move them ahead, move the family ahead. Most parents are really glad afterwards that the surgery has been done.

  • After your child's umbilical hernia repair - Animation

    After your child's umbilical hernia repair

    Animation

  • After your child's umbilical hernia repair - Animation

    So what do you do after your child's had an umbilical hernia repaired? I'm Dr. Alan Greene with some tips for home care after that operation. Well, the first thing to know is that your child will probably go home with a bandage over the surgical site that's best to leave in place until your return visit to the doctor or until your doctor tells you to take it off. And while that bandage is there you want to keep that area pretty dry. That means usually sponge baths, not real bathing, not swimming certainly until it's time for that bandage to come off. Your doctor probably will give some pain medication for your child, especially that first couple days it can be pretty tender afterwards, so it's nice to give that pain medication around the clock when they're awake to kind of stay ahead of the pain instead of waiting until you know that they're uncomfortable. They can pretty well eat what they want once they go home and more or less normal activity. You'll want it kind of quiet for the first 3 or 4 days, but after that they can resume completely normal activity except for rough sports - you probably want to hold off for about a week or so to let that incision really strengthen. When should you call the doctor? It's a good idea to call the doctor if your child develops a new fever sometime afterwards over 101° or so. If their pain is increasing at any point or if they're having trouble urinating would be another reason. If vomiting or nausea develops in the couple of days after surgery. If there's an increase in redness or if it looks to you after the bandage comes off that the wound seems to be coming apart would all be reasons to get back in touch with the doctor. Most children with this operation though have no complications and if there are complications they're pretty easily dealt with. So, enjoy this quiet time with your child and then enjoy getting right back to regular activity sometime in the next week.

  • Inguinal hernia repair - Animation

    Inguinal hernia repair

    Animation

  • Inguinal hernia repair - Animation

    Hernias are one of the most common reasons for children to need surgery. Thankfully, the risks today are very low, and the results are excellent. Let's talk about inguinal hernia repair. Before a baby is born, the testicles and ovaries begin life in the back of the belly. As the baby develops, the testicles or ovaries descend into their place in the body through a tube called the inguinal canal. If the canal doesn't close afterward some of the intestines can slip through and create a bulge, or hernia, in the baby's groin. Premature babies tend to develop hernias more than full-term babies. Boys are more likely to have hernias than girls. Hernias can also run in families, and they're often associated with other problems, like undescended testicles. How do you know if your child has an inguinal hernia?Parents usually notice a lump or bulge in their child's groin, scrotum, or labia during bath time or while changing a diaper. It may appear when the child cries or strains, and disappear when they are relaxed or asleep. Sometimes some of the intestine will get trapped in the hernia, causing pain. The child gets fussy and may cry inconsolably. If blood supply to the intestine is cut off, the bulge may be red and tender, and the child may have a fever and a racing heart rate. Inguinal hernias do not go away without treatment. The good news is a simple, safe operation can close the inguinal canal. Your child will usually receive general anesthesia, and be asleep and without pain. The surgeon will make a small cut near the hernia, push the intestine back into your child's belly, and close the inguinal canal. Your child should go home the same day. When you get your child home, don't be concerned if you notice swelling or some bruising in the area of the surgery. That's to be expected - it's normal. And you can kind of go with your child's desired level of activity for a bit. In fact, encouraging them to move some will help speed recovery, but you want to avoid really rough play or extreme activity for the first week or so until the incision begins to really repair.

  • After your child's inguinal hernia repair - Animation

    After your child's inguinal hernia repair

    Animation

  • After your child's inguinal hernia repair - Animation

    So what do you need to know after your child has had an inguinal hernia repaired? I'm Dr. Alan Greene with some tips for once you go home after inguinal hernia repair. Usually that surgery is done on a come and go basis. Your child goes home that same day and don't be concerned if you notice swelling or some bruising in the area of the surgery, that's to be expected - it's normal. And you can kind of go with your child's desired level of activity for a bit. In fact, encouraging them to move some will help speed recovery but you want to avoid really rough play or extreme activity for the first week or so until the incision begins to really repair. When should you call a doctor after the surgery? If that swelling or bruising is increasing after a couple of days, that's a good time to check in with your doctor. Same thing if bleeding is increasing or pain is increasing or redness is increasing or there's discharge from the incision after a few days. I would check in. Also with a fever over 101° or so is a good time to check in. And if there is new nausea or vomiting a day or more after the surgery. But otherwise within a week your child should be back up playing actively and in better shape than ever before.

  • Hiatal hernia - x-ray

    Hiatal hernia - x-ray

    This x-ray shows the upper portion of the stomach protruding through the diaphragm (hiatal hernia).

    Hiatal hernia - x-ray

    illustration

  • Infant abdominal hernia (gastroschisis)

    Infant abdominal hernia (gastroschisis)

    An abdominal hernia (gastroschisis) occurs when there is an area where the muscles are weak, and this allows the internal organs to bulge through the abdominal wall.

    Infant abdominal hernia (gastroschisis)

    illustration

  • Umbilical hernia

    Umbilical hernia

    An umbilical hernia is a protrusion of the peritoneum and fluid, omentum, or a portion of abdominal organ(s) through the umbilical ring. The umbilical ring is the fibrous and muscle tissue around the navel (belly-button). Small hernias usually close spontaneously without treatment by age 1 or 2. Umbilical hernias are usually painless and are common in infants.

    Umbilical hernia

    illustration

  • Infant diaphragmatic hernia

    Infant diaphragmatic hernia

    An abnormal opening in the diaphragm that allows part of the abdominal organs to migrate into the chest cavity, occurring before birth.

    Infant diaphragmatic hernia

    illustration

  • Brain hernia

    Brain hernia

    Brain hernia is a condition in which a portion of the brain is displaced because of increased pressure inside the skull. Increase in pressure results in progressive damage to brain tissue that may include life-threatening damage to the brainstem.

    Brain hernia

    illustration

  • Inguinal hernia

    Inguinal hernia

    Inguinal hernia is the result of an organ, usually bowel, protruding through a weak point or tear in the thin muscular abdominal wall. Inguinal hernias can restrict blood supply to the bowel herniated through the defect, creating a medical emergency.

    Inguinal hernia

    illustration

  • Hiatal hernia

    Hiatal hernia

    A hiatal hernia occurs when part of the stomach protrudes up into the chest through the sheet of muscle called the diaphragm. This may result from a weakening of the surrounding tissues and may be aggravated by obesity and/or smoking.

    Hiatal hernia

    illustration

  • Femoral hernia

    Femoral hernia

    A femoral hernia is a protrusion of a loop of the intestine through a weakened abdominal wall, located in the lower abdomen near the thigh.

    Femoral hernia

    illustration

  • Diaphragmatic hernia repair  - series

    Diaphragmatic hernia repair - series

    Presentation

  • Hiatal hernia repair  - series

    Hiatal hernia repair - series

    Presentation

  • Umbilical hernia repair  - series

    Umbilical hernia repair - series

    Presentation

  • Inguinal hernia repair  - series

    Inguinal hernia repair - series

    Presentation

  • Hernia - Animation

    Hernia

    Animation

  • Hernia - Animation

    You're lifting a heavy box, when suddenly, you feel a strain in your stomach or groin. If you also feel a bulge there, you might have a hernia. The bump that you feel is a part of what's in your abdomen bulging out through a weak spot in the muscle or tissue that surrounds it. A hernia is kind of like pushing your finger against the side of a balloon. What type of hernia you have depends on where the bulge is located. A femoral hernia is a bulge in the upper part of your thigh. A hiatal hernia is located in the top part of your stomach. An umbilical hernia bulges around your belly button. Inguinal hernias are in the groin area. And incisional hernias usually form around a scar from a past surgery in your abdomen. You can get a hernia if you lift something that's too heavy, or strain too hard while coughing, urinating, or having a bowel movement. Sometimes babies are born with a hernia. That happens when the lining that is supposed to hold the abdominal organs doesn't totally close before birth. Some hernias don't cause any symptoms. You might live with a hernia for a while without even noticing that you have it. Or, you may see an actual bulge in your leg, stomach, or groin. Hernias can sometimes be painful, especially when you strain or lift something heavy. Your doctor should be able to locate the hernia during an exam. If your hernia is small and doesn't bother you, you may not need to do anything but keep in touch with your doctor to make sure it isn't growing. If the hernia is big or painful, your doctor may recommend surgery to plug the opening. The one big risk to having a hernia is that with some types the tissue can get caught inside the hole. This is called strangulation. It can be very dangerous, because blood is cut off to the part of the organ that's trapped. Eventually that tissue will die. If you have a strangulated hernia, you'll need to have emergency surgery. Surgery is the only way to reverse a hernia, although in young children umbilical hernias will often go away on their own. If you have a small hernia and decide not to have surgery, be on the lookout for any changes. Call the doctor right away if you have pain, nausea, vomiting, or a fever, or if your hernia turns red, purple, or another color. These could be signs of strangulation. To avoid a hernia in the first place, be careful when lifting heavy objects. Drink plenty of fluids and add fiber to your diet so you won't have to push too hard on the toilet. And see a urologist if you're straining while urinating.

  • Prepare for your child's hernia surgery - Animation

    Prepare for your child's hernia surgery

    Animation

  • Prepare for your child's hernia surgery - Animation

    Whenever your child is going in for surgery, it's a big deal for parents and for the child also. I'm Dr. Alan Greene and I'd like to discuss with you how to prepare your child, how to get ready for hernia surgery. The good news is that when the surgery is done you get instant results. Right away the problem's been fixed. And there are just a few steps to take to make the process go as smoothly as possible. Perhaps the first thing is preparing yourself because if you're feeling confident and good about the surgery, then everything will go much easier for you and for your child. And that means getting your questions answered beforehand. And in particular, the question I hear the most from parents is concern about the anesthesia. And that comes often from anesthesia risks that happened back when we were children. Anesthesia was much more dangerous than it is today. The problem was there weren't ways to monitor whether kids were getting enough oxygen to the brain or not. But since those monitors were developed about 20 years or so ago now, anesthesia has become incredibly safe - in fact, often safer than driving to the hospital. Now there other things that are important to do to prepare. First is to remember to take notice if your doctor has ordered any lab tests before the surgery. Perhaps blood tests, perhaps urine tests, maybe nothing was needed. But if it was, you want to make sure you've gotten it done before you end up going to the hospital. The second thing are instructions should've been given to you about when is the last time your child could eat or drink before heading to the hospital. Often it'll be midnight the night before, but whatever you were told be sure to take note of that and really don't cheat on this one. Nothing after what they say. And that leads to point number 3. Whatever medications that your child is taking, prescribed medicines, over-the-counter medicines, need to be taken into account. So, make sure you discuss with your physician, your anesthesiologist or the surgeon beforehand whatever medicines your child is taking and whether they should be taken or skipped after that deadline for food and drink. Next thing that's important, number 4, is to help your child select a favorite toy or stuffed animal, action figure to bring with them to the hospital. This little dog here or something that's comforting for them to have with them along the way. And it's a great idea before the whole thing depending on the age and temperament of your child to act out the whole scenario using their favorite toy. So, for instance, this little dog is not feeling well, hasn't been feeling well for awhile, has to take lots of medications, but the doctors are going to be able to fix it. Can't eat or drink anything after midnight - every step of it you go through. They're a little bit scared and they find out everything is fine and it worked out great and they get some ice cream afterwards and the problem is all gone. But to work it through with them so they get the story and it also helps you feel more prepared. I also suggest giving children something specific and fun to look forward to shortly after the surgery. It might be something as simple as a trip to the movies together or a trip to get ice cream but something that they can focus on. Take the focus a little bit off the surgery itself. Not a bad thing for you too. Then a couple of practical things. I do suggest that before going in you take off any jewelry that the child has, you bathe them, you get rid of even earrings that may stay in all the time or hair clips that may, you don't really want those at the hospital. And it's good to choose comfortable clothes when you go to the hospital, things that are easy on, easy off. It's not a fashion show. Although you may want some pictures of this cause it is a kind of historic moment. And lastly, if your child does develop any kind of fever or rash or cold beforehand, make sure to give them a call and let the folks know what's going on cause it may mean the surgery should be postponed. But the good news is that this kind of minor surgery today in children is extraordinarily safe and when it's done for the right child at the right time really helps move them ahead, move the family ahead. Most parents are really glad afterwards that the surgery has been done.

  • After your child's umbilical hernia repair - Animation

    After your child's umbilical hernia repair

    Animation

  • After your child's umbilical hernia repair - Animation

    So what do you do after your child's had an umbilical hernia repaired? I'm Dr. Alan Greene with some tips for home care after that operation. Well, the first thing to know is that your child will probably go home with a bandage over the surgical site that's best to leave in place until your return visit to the doctor or until your doctor tells you to take it off. And while that bandage is there you want to keep that area pretty dry. That means usually sponge baths, not real bathing, not swimming certainly until it's time for that bandage to come off. Your doctor probably will give some pain medication for your child, especially that first couple days it can be pretty tender afterwards, so it's nice to give that pain medication around the clock when they're awake to kind of stay ahead of the pain instead of waiting until you know that they're uncomfortable. They can pretty well eat what they want once they go home and more or less normal activity. You'll want it kind of quiet for the first 3 or 4 days, but after that they can resume completely normal activity except for rough sports - you probably want to hold off for about a week or so to let that incision really strengthen. When should you call the doctor? It's a good idea to call the doctor if your child develops a new fever sometime afterwards over 101° or so. If their pain is increasing at any point or if they're having trouble urinating would be another reason. If vomiting or nausea develops in the couple of days after surgery. If there's an increase in redness or if it looks to you after the bandage comes off that the wound seems to be coming apart would all be reasons to get back in touch with the doctor. Most children with this operation though have no complications and if there are complications they're pretty easily dealt with. So, enjoy this quiet time with your child and then enjoy getting right back to regular activity sometime in the next week.

  • Inguinal hernia repair - Animation

    Inguinal hernia repair

    Animation

  • Inguinal hernia repair - Animation

    Hernias are one of the most common reasons for children to need surgery. Thankfully, the risks today are very low, and the results are excellent. Let's talk about inguinal hernia repair. Before a baby is born, the testicles and ovaries begin life in the back of the belly. As the baby develops, the testicles or ovaries descend into their place in the body through a tube called the inguinal canal. If the canal doesn't close afterward some of the intestines can slip through and create a bulge, or hernia, in the baby's groin. Premature babies tend to develop hernias more than full-term babies. Boys are more likely to have hernias than girls. Hernias can also run in families, and they're often associated with other problems, like undescended testicles. How do you know if your child has an inguinal hernia?Parents usually notice a lump or bulge in their child's groin, scrotum, or labia during bath time or while changing a diaper. It may appear when the child cries or strains, and disappear when they are relaxed or asleep. Sometimes some of the intestine will get trapped in the hernia, causing pain. The child gets fussy and may cry inconsolably. If blood supply to the intestine is cut off, the bulge may be red and tender, and the child may have a fever and a racing heart rate. Inguinal hernias do not go away without treatment. The good news is a simple, safe operation can close the inguinal canal. Your child will usually receive general anesthesia, and be asleep and without pain. The surgeon will make a small cut near the hernia, push the intestine back into your child's belly, and close the inguinal canal. Your child should go home the same day. When you get your child home, don't be concerned if you notice swelling or some bruising in the area of the surgery. That's to be expected - it's normal. And you can kind of go with your child's desired level of activity for a bit. In fact, encouraging them to move some will help speed recovery, but you want to avoid really rough play or extreme activity for the first week or so until the incision begins to really repair.

  • After your child's inguinal hernia repair - Animation

    After your child's inguinal hernia repair

    Animation

  • After your child's inguinal hernia repair - Animation

    So what do you need to know after your child has had an inguinal hernia repaired? I'm Dr. Alan Greene with some tips for once you go home after inguinal hernia repair. Usually that surgery is done on a come and go basis. Your child goes home that same day and don't be concerned if you notice swelling or some bruising in the area of the surgery, that's to be expected - it's normal. And you can kind of go with your child's desired level of activity for a bit. In fact, encouraging them to move some will help speed recovery but you want to avoid really rough play or extreme activity for the first week or so until the incision begins to really repair. When should you call a doctor after the surgery? If that swelling or bruising is increasing after a couple of days, that's a good time to check in with your doctor. Same thing if bleeding is increasing or pain is increasing or redness is increasing or there's discharge from the incision after a few days. I would check in. Also with a fever over 101° or so is a good time to check in. And if there is new nausea or vomiting a day or more after the surgery. But otherwise within a week your child should be back up playing actively and in better shape than ever before.

  • Hiatal hernia - x-ray

    Hiatal hernia - x-ray

    This x-ray shows the upper portion of the stomach protruding through the diaphragm (hiatal hernia).

    Hiatal hernia - x-ray

    illustration

  • Infant abdominal hernia (gastroschisis)

    Infant abdominal hernia (gastroschisis)

    An abdominal hernia (gastroschisis) occurs when there is an area where the muscles are weak, and this allows the internal organs to bulge through the abdominal wall.

    Infant abdominal hernia (gastroschisis)

    illustration

  • Umbilical hernia

    Umbilical hernia

    An umbilical hernia is a protrusion of the peritoneum and fluid, omentum, or a portion of abdominal organ(s) through the umbilical ring. The umbilical ring is the fibrous and muscle tissue around the navel (belly-button). Small hernias usually close spontaneously without treatment by age 1 or 2. Umbilical hernias are usually painless and are common in infants.

    Umbilical hernia

    illustration

  • Infant diaphragmatic hernia

    Infant diaphragmatic hernia

    An abnormal opening in the diaphragm that allows part of the abdominal organs to migrate into the chest cavity, occurring before birth.

    Infant diaphragmatic hernia

    illustration

  • Brain hernia

    Brain hernia

    Brain hernia is a condition in which a portion of the brain is displaced because of increased pressure inside the skull. Increase in pressure results in progressive damage to brain tissue that may include life-threatening damage to the brainstem.

    Brain hernia

    illustration

  • Inguinal hernia

    Inguinal hernia

    Inguinal hernia is the result of an organ, usually bowel, protruding through a weak point or tear in the thin muscular abdominal wall. Inguinal hernias can restrict blood supply to the bowel herniated through the defect, creating a medical emergency.

    Inguinal hernia

    illustration

  • Hiatal hernia

    Hiatal hernia

    A hiatal hernia occurs when part of the stomach protrudes up into the chest through the sheet of muscle called the diaphragm. This may result from a weakening of the surrounding tissues and may be aggravated by obesity and/or smoking.

    Hiatal hernia

    illustration

  • Femoral hernia

    Femoral hernia

    A femoral hernia is a protrusion of a loop of the intestine through a weakened abdominal wall, located in the lower abdomen near the thigh.

    Femoral hernia

    illustration

  • Diaphragmatic hernia repair  - series

    Diaphragmatic hernia repair - series

    Presentation

  • Hiatal hernia repair  - series

    Hiatal hernia repair - series

    Presentation

  • Umbilical hernia repair  - series

    Umbilical hernia repair - series

    Presentation

  • Inguinal hernia repair  - series

    Inguinal hernia repair - series

    Presentation


Review Date: 9/3/2018

Reviewed By: Debra G. Wechter, MD, FACS, general surgery practice specializing in breast cancer, Virginia Mason Medical Center, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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