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diaphragm injury

Christina L Greene, Richard D Mainwaring, Douglas Sidell, Vamsi V Yarlagadda, William L Patrick, Frank L Hanley
OBJECTIVES: Injury to the phrenic nerves may occur during surgery for Pulmonary Atresia with Ventricular Septal Defect and Major Aortopulmonary Collateral Arteries (PA/VSD/MAPCAs). These patients may develop respiratory failure and require diaphragm plication. The purpose of this study was to evaluate the impact of phrenic nerve palsy on recovery following surgery for PA/VSD/MAPCAs. METHODS: Between 2007 to 2016, approximately 500 patients have undergone surgery for PA/VSD/MAPCAs at our institution...
March 12, 2018: Seminars in Thoracic and Cardiovascular Surgery
Ingmar L Defize, Bernadette Schurink, Teus J Weijs, Tom A P Roeling, Jelle P Ruurda, Richard van Hillegersberg, Ronald L A W Bleys
BACKGROUND: Injury and subsequent leakage of unrecognized thoracic duct tributaries during transthoracic esophagectomy may lead to chylothorax. Therefore, we hypothesized that thoracic duct anatomy at the diaphragm is more complex than currently recognized and aimed to provide a detailed description of the anatomy of the thoracic duct at the diaphragm. BASIC PROCEDURES: The thoracic duct and its tributaries were dissected in 7 (2 male and 5 female) embalmed human cadavers...
March 3, 2018: Annals of Anatomy, Anatomischer Anzeiger: Official Organ of the Anatomische Gesellschaft
Tristan Monchal, Amina Ndiaye, Blandine Gadegbeku, Etienne Javouhey, Olivier Monneuse
Objective Road traffic accidents (RTA) are the first cause of abdominopelvic injuries (API). The objective of this study was to describe the characteristics and severity of API due to traffic accidents in a large French trauma registry and to identify risk factors for API. Methods All victims from the French Rhône registry of victims of RTA were analyzed from 1996 to 2013. This registry contained data that were issued over a 20-year period from 245 medical departments, from prehospital care until re-adaptation, and forensic medicine departments...
March 6, 2018: Traffic Injury Prevention
Zhimei Lv, Mengsi Hu, Minghua Fan, Xiaobing Li, Jiangong Lin, Junhui Zhen, Ziyang Wang, Haijun Jin, Rong Wang
Activation of Ras-related C3 botulinum toxin substrate 1 (Rac1) has been implicated in diverse kidney diseases, yet its in vivo significance in diabetic nephropathy (DN) is largely unknown. In the present study, we demonstrated a podocyte-specific Rac1-deficient mouse strain and showed that specific inhibition of Rac1 was able to attenuate diabetic podocyte injury and proteinuria by the blockade of Rac1/PAK1/p38/β-catenin signaling cascade, which reinstated the integrity of podocyte slit diaphragms (SD), rectified the effacement of foot processes (FPs), and prevented the dedifferentiation of podocytes...
March 1, 2018: Cell Death & Disease
Chitralekha Patra, Naveen G Singh, N Manjunatha, Anand Bhatt
Eventration of the diaphragm is a rare entity, characterised by abnormal elevation of a dome of diaphragm. In this condition, the diaphragm is composed of fibrous tissue with few or no interspersed muscle fibres. Eventration can be congenital or acquired. Congenital eventration results from inadequate development of muscles or absence of phrenic nerve. The common cause of acquired eventration is injury to the phrenic nerve from traumatic birth injury or surgery for heart disease. The perioperative anaesthetic management of diaphragmatic eventration along with ventricular septal defect with severe pulmonary hypertension makes this case both challenging and unique...
February 2018: Indian Journal of Anaesthesia
Lijun Jiang, Tingting Tao, Junnan Zheng, Zhen Jia, Hongfei Xu, Yiming Ni
RATIONALE: A 35-year old Chinese female was admitted to hospital with refractory pericardial effusions 10 days post mitral valve replacement via median sternotomy. We performed an exploratory resternotomy and found lymphatic leakage on the surface of the diaphragm which was continuously emitting a light yellow fluid. PATIENT CONCERNS: The patient complained of no obvious discomfort except for the concern of massive pericardial effusion drainage. DIAGNOSES: Exploratory resternotomy and biochemical testing lead to a supradiaphragmatic lymphatic fistula being diagnosed as the cause of the refractory pericardial effusion...
March 2018: Medicine (Baltimore)
Daisuke Hara, Gaku Saito, Fumiaki Shimizu, Fumitaka Suzuki, Yoshikazu Arai, Takayuki Shiina
A 53-year-old man with a penetrating trauma was admitted to our hospital. Thoracoabdominal computed tomography (CT) on admission showed left diaphragmatic injury and peritoneal fat in the left thoracic cavity. Under a diagnosis of the traumatic diaphragmatic injury, an emergency operation was performed, and the left diaphragm was repaired. No other injuries were found in the thoracic and abdominal organs by thoraco-laparoscopic observation. The postoperative course was uneventful, and the patient left hospital on the 14th day after surgery...
February 2018: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Mark W Urban, Biswarup Ghosh, Laura R Strojny, Cole G Block, Sara M Blazejewski, Megan C Wright, George M Smith, Angelo C Lepore
Damage to respiratory neural circuitry and consequent loss of diaphragm function is a major cause of morbidity and mortality in individuals suffering from traumatic cervical spinal cord injury (SCI). Repair of CNS axons after SCI remains a therapeutic challenge, despite current efforts. SCI disrupts inspiratory signals originating in the rostral ventral respiratory group (rVRG) of the medulla from their phrenic motor neuron (PhMN) targets, resulting in loss of diaphragm function. Using a rat model of cervical hemisection SCI, we aimed to restore rVRG-PhMN-diaphragm circuitry by stimulating regeneration of injured rVRG axons via targeted induction of Rheb (ras homolog enriched in brain), a signaling molecule that regulates neuronal-intrinsic axon growth potential...
February 14, 2018: Experimental Neurology
Sarah J Counts, Areo G Saffarzadeh, Justin D Blasberg, Anthony W Kim
This case involves a 70-year-old woman who presented after a low-speed motor vehicle collision with a traumatic right hemidiaphragm rupture and herniation of the liver into the right chest. She was brought to the operating room for a robotic-assisted minimally invasive transthoracic repair of this hernia with diaphragm plication. The case and video described in this report highlight the utility of the robotic platform in performing a transthoracic diaphragm repair and plication after a right-sided traumatic diaphragm rupture in a patient without concomitant abdominal injuries...
February 13, 2018: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Laxmi Kokatnur, Mohan Rudrappa
The diaphragm is the primary muscle of respiration, and its weakness can lead to respiratory failure. Diaphragmatic palsy can be caused by various causes. Injury to the phrenic nerve during thoracic surgeries is the most common cause for diaphragmatic palsy. Depending on the cause, the symptoms of diaphragmatic palsies vary from completely asymptomatic to disabling dyspnea requiring mechanical ventilation. On pulmonary function tests, there will be a decrease in the maximum respiratory muscle power. Spirometry shows reduced lung functions and a significant drop of lung function in supine position is typical of diaphragmatic palsy...
February 13, 2018: Diseases (Basel)
Megan Stevens, Christopher R Neal, Andrew H J Salmon, David O Bates, Steven J Harper, Sebastian Oltean
BACKGROUND/AIMS: Genetic cell ablation using the human diphtheria toxin receptor (hDTR) is a new strategy used for analysing cellular function. Diphtheria toxin (DT) is a cytotoxic protein that leaves mouse cells relatively unaffected, but upon binding to hDTR it ultimately leads to cell death. We used a podocyte-specific hDTR expressing (Pod-DTR) mouse to assess the anti-permeability and cyto-protective effects of the splice isoform vascular endothelial growth factor (VEGF-A165b). METHODS: The Pod-DTR mouse was crossed with a mouse that over-expressed VEGF-A165b specifically in the podocytes (Neph-VEGF-A165b)...
January 26, 2018: Nephron
Pradeep Navsaria, Andrew Nicol, Jake Krige, Sorin Edu, Sharfuddin Chowdhury
PURPOSE: Nonoperative management (NOM) of gunshot liver injuries (GLI) is infrequently practiced. The aim of this study was to assess the safety of selective NOM of GLI. METHODS: A prospective, protocol-driven study, which included patients with GLI admitted to a level 1 trauma center, was conducted over a 52-month period. Stable patients without peritonism or sustained hypotension with right-sided thoracoabdominal (RTA) and right upper quadrant (RUQ), penetrating wounds with or without localized RUQ tenderness, underwent contrasted abdominal CT scan to determine the trajectory and organ injury...
January 24, 2018: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Jean-Claude Stamegna, Kevin Sadelli, Guy Escoffier, Stéphane D Girard, Antoine D Veron, Amandine Bonnet, Michel Khrestchatisky, Patrick Gauthier, Francois Roman
The transplantation of Olfactory Ecto-Mesenchymal Stem Cells (OEMSCs) could be a helpful therapeutic strategy for spinal cord repair. Using an acute rat model of high cervical contusion that provokes a persistent hemi-diaphragmatic and foreleg paralysis, we evaluated the therapeutic effect of a delayed syngeneic transplantation (two days post-contusion) of OEMSCs within the injured spinal cord. Respiratory function was assessed using diaphragmatic electromyography and neuro-electrophysiological recordings of phrenic nerves (innervating the diaphragm)...
January 22, 2018: Journal of Neurotrauma
F Köckerling, C Schug-Pass, R Bittner
BACKGROUND: The mesh fixation technique used in repair of hiatal hernias and subxiphoid ventral and incisional hernias must meet strenuous requirements. In the literature, there are reports of life-threatening complications with cardiac tamponade and a high mortality rate on using tacks. The continuing practice of tack deployment for mesh fixation to the diaphragm and esophageal hiatus should be critically reviewed. METHODS: In a systematic search of the available literature in May 2017, 23 cases of severe penetrating cardiac complications were identified...
January 16, 2018: Surgical Endoscopy
Volkan Karacam, Aydin Sanli, Kemal Can Tertemiz, Ilknur Ulugun
INTRODUCTION: Diaphragm pacing stimulation (DPS) is a treatment method used in respiratory failure occurs in diseases such as high-level cervical spinal cord injury, central hypoventilation syndrome and amyotrophic lateral sclerosis. MATERIALS AND METHODS: A total of 43 patients, who had undergone DPS implantation surgery were evaluated retrospectively. The patients were divided into two groups according to the surgical technique (Group 1: classical surgical technic and Group 2: modified surgical technic) applied...
January 10, 2018: Journal of Minimal Access Surgery
Victoria Marie Spruance, Lyandysha Viktorovna Zholudeva, Kristiina M Hormigo, Margo L Randelman, Tatiana Bezdudnaya, Vitaliy Marchenko, Michael A Lane
Cervical spinal cord injuries (SCI) result in devastating functional consequences, including respiratory dysfunction. This is largely due to the disruption of phrenic pathways, which control the diaphragm. Recent work has identified spinal interneurons as possible contributors to respiratory neuroplasticity. The present work investigated whether transplantation of developing spinal cord tissue, inherently rich in interneuronal progenitors, could provide a population of new neurons and growth permissive substrate to facilitate plasticity and formation of novel relay circuits to restore input to the partially denervated phrenic motor circuit...
January 2, 2018: Journal of Neurotrauma
Arata Oda, Liisa Lehtonen, Hanna Soukka
Neurally adjusted ventilatory assist (NAVA) is a mode of mechanical ventilation that triggers, cycles and delivers assistance in response to the electrical activity of the diaphragm (EAdi). The EAdi signal is measured with an EAdi catheter (Maquet, Solna, Sweden) that includes nine miniaturised electrodes and is positioned in the oesophagus at the level of the diaphragm. NAVA has been shown to decrease peak inspiratory pressures, which are potentially harmful for immature lungs (1,2) and, therefore, it may decrease ventilator induced lung injury, particularly pulmonary hypoplasia in congenital diaphragmatic hernia (CDH)...
December 16, 2017: Acta Paediatrica
G F Malherbe, P H Navsaria, A J Nicol, S Edu, S Chowdhury
BACKGROUND: The purpose of this study was to determine whether patients with left-sided thoracoabdominal (TA) stab wounds can be safely treated with clinical and chest X-ray follow up. METHOD: A prospective, randomized control study was conducted at Groote Schuur Hospital from September 2009 through to November 2014. Patients with asymptomatic left TA stab wounds included in the trial were randomized into two groups. Group A underwent diagnostic laparoscopy and Group B underwent clinical and radiological follow-up...
November 2017: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
Baojun Wang, Hongzhao Li, Qingbo Huang, Kan Liu, Yang Fan, Cheng Peng, Liangyou Gu, Xintao Li, Gang Guo, Rong Liu, Minggen Hu, Guodong Zhao, Hongguang Wang, Fengyong Liu, Jiang Xiong, Xu Zhang, Xin Ma
BACKGROUND: Robot-assisted retrohepatic inferior vena cava (IVC) thrombectomy (RA-R-IVCTE) has been reported only for limited series. OBJECTIVE: To describe in detail the techniques for RA-R-IVCTE with regard to the relationship of a proximal thrombus to either the first porta hepatis (FPH) or second porta hepatis (SPH). DESIGN, SETTING, AND PARTICIPANTS: From May 2013 to July 2016, 22 patients with R-IVC tumor thrombi were admitted to our hospital...
December 7, 2017: European Urology
Biliana Lozanoska-Ochser, Anna Benedetti, Giuseppe Rizzo, Valeria Marrocco, Rosanna Di Maggio, Piera Fiore, Marina Bouche
Chronic muscle inflammation is a critical feature of Duchenne muscular dystrophy and contributes to muscle fibre injury and disease progression. Although previous studies have implicated T cells in the development of muscle fibrosis, little is known about their role during the early stages of muscular dystrophy. Here, we show that T cells are among the first cells to infiltrate mdx mouse dystrophic muscle, prior to the onset of necrosis, suggesting an important role in early disease pathogenesis. Based on our comprehensive analysis of the kinetics of the immune response, we further identify the early pre-necrotic stage of muscular dystrophy as the relevant time frame for T-cell-based interventions...
March 2018: Journal of Pathology
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