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Diaphragmatic hernia managment

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https://www.readbyqxmd.com/read/28070244/assessment-of-fetus-during-second-trimester-ultrasonography-using-hdlive-software-what-is-its-real-application-in-the-obstetrics-clinical-practice
#1
Gabriele Tonni, Gianpaolo Grisolia, Eduardo Félix Santana, Edward Araujo Júnior
AIM: To show imaging results from application of four-dimensional (4D) ultrasound lightening technique (HDlive™) in clinical obstetrics practice. METHODS: Normal and abnormal fetuses at second and third trimester of pregnancy undergoing routine scan with 4D HDlive™ (5DUS) in the rendering mode are described. Realistic features of fetal structures were provided by 5DUS in the rendering mode. Normal anatomy as well as pathology like cleft lip, hypoplastic face, micrognathia, low-set ears, corpus callosum, arthrogryposis, aortic arch, left congenital diaphragmatic hernia are highlighted in this study...
December 28, 2016: World Journal of Radiology
https://www.readbyqxmd.com/read/28050431/asymptomatic-traumatic-hepatothorax-symptomatic-gall-stone-disease-a-rare-coincidence
#2
Somak Das, Dinesh Zirpe, Chandrasekharn Valiathan Gopakumar, Sudeepta Kumar Swain, Rajagopal Surendran
Traumatic diaphragmatic hernia rarely affects right side due to protective effect of liver. In adult it is mainly caused by blunt abdominal trauma. Acute presentations are often life threatening and usually clinch the diagnosis early. It may remain asymptomatic for many years unless being detected incidentally during investigations for some unrelated reason or getting complicated by some pathology of herniated viscera. High degree of suspicion is required to detect this delayed presentation particularly in a post-trauma patient as this condition may require modifications in management...
November 2016: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28029369/management-and-outcomes-of-scoliosis-in-children-with-congenital-diaphragmatic-hernia
#3
Ryan M Antiel, John S Riley, Patrick J Cahill, Robert M Campbell, Lindsay Waqar, Lisa M Herkert, Natalie E Rintoul, William H Peranteau, Alan W Flake, N Scott Adzick, Holly L Hedrick
PURPOSE: The purpose of this study was to evaluate the management and outcomes of CDH patients with scoliosis. METHODS: From January 1996 to August 2015, 26 of 380 (7%) CDH patients were diagnosed with scoliosis. Six (23%) were prenatally diagnosed by ultrasound, and 9 (35%) were diagnosed postnatally. The remaining 11 (42%) developed scoliosis after discharge. Mean follow-up was 6.6years. RESULTS: Among the 15 patients with congenital scoliosis, there were 2 (13%) perinatal deaths...
September 15, 2016: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/28005161/-epidural-anesthesia-for-fetoscopy-retrospective-analysis-of-a%C3%A2-one-year-cohort
#4
N Kiefer, S F Suter, C Berg, U Gembruch, S U Weber
BACKGROUND: The introduction of routine prenatal screening using ultrasound has led to a substantial increase in diagnoses of fetal disorders that are amenable to intrauterine treatment. While an ultrasound guided insertion of small bore cannulas can be performed under local anesthesia, insertion of a fetoscope usually requires anesthetic management for the mother and the fetus. Additionally, the fetus' intrauterine position may have to be manipulated in order to enable access. Such manoeuvres depend on relaxation of the mother's abdominal wall...
December 22, 2016: Der Anaesthesist
https://www.readbyqxmd.com/read/27994343/neonatal-intrathoracic-stomach-without-gastric-volvulus
#5
Sriharsha Bokka, Manoj Kumar Mohanty
Intrathoracic stomach is a rare and serious congenital abnormality. The anomaly may be complicated by gastric volvulus and can lead to ischemic gastric infarction in the neonate. If diagnosed antenatally, neonatal management can be planned in advance so as to reduce morbidity. This anomaly must be differentiated from the more common congenital diaphragmatic hernia, as associated pulmonary hypoplasia is common in the latter and rare with gastric herniation. We report a case of intrathoracic stomach in a neonate without volvulus, fortunately a rare entity which was managed operatively, and the child has been under regular follow-up...
October 2016: Indian Journal of Surgery
https://www.readbyqxmd.com/read/27986977/risk-factors-for-postoperative-mortality-in-congenital-diaphragmatic-hernia-a-single-centre-observational-study
#6
Darya Kadir, Helene Engstrand Lilja
BACKGROUND: The management of congenital diaphragmatic hernia (CDH) is a major challenge. The mortality is dependent on associated malformations, the severity of pulmonary hypoplasia, pulmonary hypertension and iatrogenic lung injury associated with aggressive mechanical ventilation. The aims of the study were to investigate the mortality over time in a single paediatric surgical centre, to compare the results with recent reports and to define the risk factors for mortality. METHODS: The medical records of infants with CDH from two time periods: 1995-2005 and 2006-2016 were reviewed...
December 16, 2016: Pediatric Surgery International
https://www.readbyqxmd.com/read/27942727/quantifying-the-burden-of-interhospital-cost-variation-in-pediatric-surgery-implications-for-the-prioritization-of-comparative-effectiveness-research
#7
Danielle B Cameron, Dionne A Graham, Carly E Milliren, Charity C Glass, Christina Feng, Feroze Sidhwa, Hariharan Thangarajah, Matthew Hall, Shawn J Rangel
Importance: Practice variation is believed to be a driver of excess health care spending, although few objective data exist to guide the prioritization of comparative effectiveness research (CER) in pediatric surgery. Objective: To identify high-priority general pediatric surgical procedures for CER on the basis of the following 2 complementary measures: the magnitude of interhospital cost variation as a surrogate for the need for and potential effect of CER at the patient level and the cumulative fiscal burden of this cost variation when considering the case volume from all hospitals as a surrogate for public health relevance...
December 12, 2016: JAMA Pediatrics
https://www.readbyqxmd.com/read/27940774/venovenous-ecmo-for-congenital-diaphragmatic-hernia-role-of-ductal-patency-and-lung-recruitment
#8
Andrea Moscatelli, Stefano Pezzato, Gianluca Lista, Lara Petrucci, Silvia Buratti, Elio Castagnola, Pietro Tuo
We report a case of antenatally diagnosed left-sided congenital diaphragmatic hernia, managed on venovenous extracorporeal membrane oxygenation with an hemodynamic and ventilation strategy aimed at preventing left and right ventricular dysfunction. Keeping the ductus arteriosus open with prostaglandin infusion and optimizing lung recruitment were effective in achieving hemodynamic stabilization and an ideal systemic oxygen delivery. The patient was discharged from the hospital and had normal development at 1 year of age...
November 2016: Pediatrics
https://www.readbyqxmd.com/read/27926636/feasibility-and-outcomes-of-fetoscopic-tracheal-occlusion-for-severe-left-diaphragmatic-hernia
#9
Michael A Belfort, Oluyinka O Olutoye, Darrell L Cass, Olutoyin A Olutoye, Christopher I Cassady, Amy R Mehollin-Ray, Alireza A Shamshirsaz, Stephanie M Cruz, Timothy C Lee, David G Mann, Jimmy Espinoza, Stephen E Welty, Caraciolo J Fernandes, Rodrigo Ruano
OBJECTIVE: To evaluate feasibility and initial outcomes of fetoscopic tracheal occlusion for severe diaphragmatic hernia compared with a historical cohort who had not received fetal tracheal occlusion. METHODS: Outcomes in a prospective observational cohort who underwent fetoscopic tracheal occlusion for severe fetal left diaphragmatic hernia without associated anomalies were compared with our historical nontreated cohort of matched fetuses of similar severity. Fetuses were classified using the same ultrasonography and magnetic resonance imaging methodology-prospectively in the fetoscopic tracheal occlusion group and retrospectively in the historical nontreated cohort...
January 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/27891284/strangulated-morgagni-s-hernia-a-rare-diagnosis-and-management
#10
Malav Modi, Amit Kumar Dey, Ajay Mate, Samir Rege
Morgagni hernia is a rare type of congenital diaphragmatic hernia. It accounts for only 3% of all diaphragmatic hernias. The defect is small and hernia being asymptomatic in the majority presents late in adulthood. Obstruction or incarceration in Morgagni hernia is uncommon. We report a rare occurrence of strangulated Morgagni hernia. A 40-year-old gentleman presented to our emergency department with features of intestinal obstruction. Computed tomography of the chest and abdomen showed a strangulated right Morgagni hernia...
2016: Case Reports in Surgery
https://www.readbyqxmd.com/read/27872422/spleen-behind-the-heart-complicates-lung-to-head-ratio-measurement-in-left-sided-congenital-diaphragmatic-hernia
#11
Amaya M Basta, Leslie A Lusk, Roberta L Keller, Roy A Filly
In fetuses with left-sided congenital diaphragmatic hernia, intrathoracic herniation of the spleen is a common occurrence. The herniated spleen can reside posterior to the left atrium of the heart in the right hemithorax and is increasingly differentiated from the lung with the use of newer sonographic equipment. Estimation of the neonatal prognosis relies on accurate measurement of fetal lung size, particularly with commonly used measurements such as the lung-to-head ratio. Here we describe how herniation of the spleen behind the heart can complicate measurement of the lung-to-head ratio on sonography and lead to overestimation, with implications for perinatal prognostication and management...
December 2016: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
https://www.readbyqxmd.com/read/27852660/massive-symptomatic-right-sided-bochdalek-hernia-in-an-adult-man
#12
Naman Kohli, Goran Mitreski, Cheng-Hon Yap, Matthew Leong
A 22-year-old man presented to a rural hospital in Australia with right-sided pleuritic chest pain, right shoulder pain and dyspnoea. The patient had been receiving chronic asthma therapy without improvement. CT of the chest was performed after an abnormal X-ray, incidentally revealing one of the largest documented right-sided diaphragmatic hernias, with left lung compression due to mediastinal shift. The patient was definitively managed with thoracotomy alone. The contents of the hernia sac included colon and multiple loops of small bowel with a 10 cm neck...
November 15, 2016: BMJ Case Reports
https://www.readbyqxmd.com/read/27756029/dual-mesh-repair-for-a-large-diaphragmatic-hernia-defect-an-unusual-case-report
#13
Metin Ercan, Mehmet Aziret, Kerem Karaman, Birol Bostancı, Musa Akoğlu
INTRODUCTION: Diaphragmatic hernia secondary to traumatic rupture is a rare entity which can occur after stab wound injuries or blunt abdominal traumas. We aimed to report successfully management of dual mesh repair for a large diaphragmatic defect. CASE REPORT: A 66-year-old male was admitted with a right sided diaphragmatic hernia which occurred ten years ago due to a traffic accident. He had abdominal pain with worsened breath. Chest X-ray showed an elevated right diaphragm...
2016: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/27727001/extracorporeal-membrane-oxygenation-for-neonatal-congenital-diaphragmatic-hernia-the-initial-single-center-experience-in-taiwan
#14
Wan-Ting Hung, Shu-Chien Huang, Dania El Mazloum, Wen-Hsi Lin, Hui-Hsin Yang, Hung-Chieh Chou, En-Ting Wu, Chien-Yi Chen, Po-Nien Tsao, Wu-Shiun Hsieh, Wen-Ming Hsu, Yih-Sharng Chen, Hong-Shiee Lai
BACKGROUND/PURPOSE: Extracorporeal membrane oxygenation (ECMO) is a treatment option for stabilizing neonates with congenital diaphragmatic hernia (CDH) in a critical condition when standard therapy fails. However, the use of this approach in Taiwan has not been previously reported. METHODS: The charts of all neonates with CDH treated in our institute during the period 2007-2014 were reviewed. After 2010, patients who could not be stabilized with conventional treatment were candidates for ECMO...
October 7, 2016: Journal of the Formosan Medical Association, Taiwan Yi Zhi
https://www.readbyqxmd.com/read/27712890/acute-gastrointestinal-compromise-in-neonates-with-congenital-diaphragmatic-hernia-prior-to-repair
#15
Catherine Fox, Michael Stewart, Sebastian K King, Neil Patel
BACKGROUND: Congenital diaphragmatic hernia (CDH) affects 1 in 3000 live births. Modern management strategies include delayed repair of the diaphragm to permit pre-operative optimization of cardiorespiratory status. We describe a cohort of neonates in whom early emergency operative intervention was required for potentially fatal intestinal compromise. METHODS: A retrospective review was performed of all neonatal CDH patients managed at a tertiary center in an 8-year period (2005-2012)...
December 2016: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/27695209/intragastric-pressure-useful-indicator-in-the-management-of-congenital-diaphragmatic-hernia
#16
Kartik Chandra Mandal, Pankaj Halder, Shibsankar Barman, Rajarshi Kumar, Biswanath Mukhopadhyay, Ram Mohan Shukla
AIMS: To assess the role of measuring of intragastric pressure (IGP) during closure of congenital diaphragmatic hernia. MATERIALS AND METHODS: Thirty-two cases were included in the study (August 2008 to February 2014), and IGP has been measured intraoperatively during closure. RESULT: Patients were categorized in group A (15 patients), group B (14 patients) and group C (3 patients). In group C, IGP was more than 30 cm of water pressure and all of tehm required creation of ventral hernia and ventilator support...
October 2016: Journal of Indian Association of Pediatric Surgeons
https://www.readbyqxmd.com/read/27635388/emergency-corrective-surgery-of-congenital-diaphragmatic-hernia-with-pulmonary-hypertension-prolonged-use-of-dexmedetomidine-as-a-pharmacologic-adjunct
#17
Badri Prasad Das, Anil Prasad Singh, Ram Badan Singh
INTRODUCTION: Underdevelopment of the lung parenchyma associated with abnormal growth of pulmonary vasculature in neonates with congenital diaphragmatic hernia results in pulmonary hypertension which mandates smooth elective mechanical ventilation in postoperative period, for proper alveolar recruitment and oxygenation, allowing lungs to mature enough for its functional anatomy and physiology. Dexmedetomidine is sympatholytic, reduces pulmonary vascular resistance and exerts sedative and analgesic property to achieve stable hemodynamics during elective ventilation...
June 2016: Anesthesiology and Pain Medicine
https://www.readbyqxmd.com/read/27605660/emergency-repair-of-morgagni-hernia-with-partial-gastric-volvulus-our-approach
#18
Kasra Razi, Duncan Light, Liam Horgan
Morgagni hernias are a rare form of congenital diaphragmatic hernias, thus there is paucity in literature about the diagnosis and management of the condition. We report an 83-year-old woman who presented with vomiting and a metabolic acidosis with a previous computed tomography diagnosis of Bochdalek's hernia. Diagnostic laparoscopy revealed a Morgagni hernia containing transverse colon, greater curvature of the stomach and a partial gastric volvulus. The hernia was reduced with the sac untouched, and the defect was closed with a composite mesh using tac fixation...
2016: Journal of Surgical Case Reports
https://www.readbyqxmd.com/read/27595907/anesthesia-for-traumatic-diaphragmatic-hernia-associated-with-corneal-laceration
#19
Reza Safaeian, Valiollah Hassani, Hamid Reza Faiz
BACKGROUND Diaphragmatic rupture can be seen in up to 5% of car accidents, and 80%-100% of diaphragmatic hernias are associated with other vital organ injuries. Brain, pelvis, long bones, liver, spleen, and aorta are some other organs that can be severely damaged and need different anesthetic managements. CASE REPORT A 37-year-old male victim of a head-on collision who was suffering diaphragmatic rupture and corneal laceration was prepared for an emergency operation 11 hours after the car accident. Gastric decompression, pre-oxygenation, rapid sequence induction with succinylcholine, immediate use of non-depolarizing muscle relaxant, and mechanical ventilation with low tidal volume after intubation were used in anesthetic management of the patient...
September 6, 2016: American Journal of Case Reports
https://www.readbyqxmd.com/read/27521424/clinically-relevant-timing-of-antenatal-sildenafil-treatment-reduces-pulmonary-vascular-remodeling-in-congenital-diaphragmatic-hernia
#20
Daphne S Mous, Heleen M Kool, Marjon J Buscop-van Kempen, Anton H Koning, Oleh Dzyubachyk, Rene M H Wijnen, Dick Tibboel, Robbert J Rottier
Patients with congenital diaphragmatic hernia (CDH) suffer from severe pulmonary hypertension attributable to altered development of the pulmonary vasculature, which is often resistant to vasodilator therapy. Present treatment starts postnatally even though significant differences in the pulmonary vasculature are already present early during pregnancy. We examined the effects of prenatal treatment with the phosphodiesterase-5 inhibitor sildenafil on pulmonary vascular development in experimental CDH starting at a clinically relevant time...
October 1, 2016: American Journal of Physiology. Lung Cellular and Molecular Physiology
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