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Diaphragmatic hernia managment

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https://www.readbyqxmd.com/read/29150031/thoracic-surgery-in-the-pregnant-patient
#1
REVIEW
Brian Whang
Thoracic surgeons are sometimes asked to consult on the management of a patient who is pregnant. Conditions commonly encountered are empyema, spontaneous pneumothorax, and diaphragmatic hernia. Lung cancer is rarely seen in pregnancy, but its incidence is rising. Diagnostic imaging and perioperative management involve the navigation of fetal risks and nuances in maternal physiology. Shared decision making within a multidisciplinary framework will optimally guide the course of management.
February 2018: Thoracic Surgery Clinics
https://www.readbyqxmd.com/read/29138242/role-of-ecmo-in-congenital-diaphragmatic-hernia
#2
REVIEW
Merrill McHoney, Philip Hammond
Congenital diaphragmatic hernia (CDH) is typified morphologically by failure of diaphragmatic development with accompanying lung hypoplasia and persistent pulmonary hypertension of the newborn (PPHN). Patients who have labile physiology and low preductal saturations despite optimal ventilatory and inotropic support may be considered for extracorporeal membrane oxygenation (ECMO). Systematic reviews into the benefits of ECMO in CDH concluded that any benefit is unclear. Few randomised trials exist to demonstrate clear benefit and guide management...
November 14, 2017: Archives of Disease in Childhood. Fetal and Neonatal Edition
https://www.readbyqxmd.com/read/29117038/development-and-validation-of-extracorporeal-membrane-oxygenation-mortality-risk-models-for-congenital-diaphragmatic-hernia
#3
Yigit S Guner, Danh V Nguyen, Lishi Zhang, Yanjun Chen, Matthew T Harting, Peter Rycus, Ryan Barbaro, Matteo Di Nardo, Thomas V Brogan, John P Cleary, Peter T Yu
The purpose of our study was to develop and validate extracorporeal membrane oxygenation (ECMO)-specific mortality risk models for congenital diaphragmatic hernia (CDH). We utilized the data from the Extracorporeal Life Support Organization Registry (2000-2015). Prediction models were developed using multivariable logistic regression. We identified 4,374 neonates with CDH with an overall mortality of 52%. Predictive discrimination (C statistic) for pre-ECMO mortality model was C = 0.65 (95% confidence interval, 0...
November 7, 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29106923/impact-of-objective-echocardiographic-criteria-for-timing-of-congenital-diaphragmatic-hernia-repair
#4
Scott Deeney, Lisa W Howley, Maggie Hodges, Kenneth W Liechty, Ahmed I Marwan, Jason Gien, John P Kinsella, Timothy M Crombleholme
OBJECTIVE: To assess the impact of specific echocardiographic criteria for timing of congenital diaphragmatic hernia repair on the incidence of acute postoperative clinical decompensation from pulmonary hypertensive crisis and/or acute respiratory decompensation, with secondary outcomes including survival to discharge, duration of ventilator support, and length of hospitalization. STUDY DESIGN: The multidisciplinary congenital diaphragmatic hernia management team instituted a protocol in 2012 requiring the specific criterion of echocardiogram-estimated pulmonary artery pressure ≤80% systemic blood pressure before repairing congenital diaphragmatic hernias...
October 26, 2017: Journal of Pediatrics
https://www.readbyqxmd.com/read/29078158/iatrogenic-gastric-perforation-in-a-misdiagnosed-case-of-late-presenting-congenital-diaphragmatic-hernia-report-of-an-avoidable-complication
#5
Pradeep Kajal, Namita Bhutani, Mohit Goyal, Poonam Kamboj
INTRODUCTION: Congenital diaphragmatic hernia (CDH) is a defect in diaphragm which usually presents with severe respiratory distress in neonatal period. PRESENTATION OF CASE: We present a case of congenital diaphragmatic hernia presenting at an age of 2.5 years in a male child. It was misdiagnosed as a case of pyothorax for which chest tube was attempted on left side resulting in iatrogenic gastric perforation. The patient was managed by early and prompt surgery...
October 12, 2017: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/29054892/transthoracic-littre-s-hernia-presenting-with-faecopneumothorax-following-perforation-of-the-meckel-s-diverticulum-a-late-complication-of-oesophagectomy
#6
Charles West, Karen Erskine, Khaled Hamdan
A Littre's hernia is an unusual phenomenon where a Meckel's diverticulum protrudes through a potential abdominal opening. We wish to present a unique case of a 79-year-old man with respiratory distress following a fall from standing, initially managed as a haemothorax. After a chest drain was placed, bowel contents were drained from the pleural cavity and he was taken to theatre. He had a history of minimally invasive oesophagectomy for cancer and had subsequently developed a diaphragmatic hernia. A blind ending diverticulum with a perforation at its tip was found in the left oblique lung fissure that was subsequently confirmed histologically as a perforated Meckel's diverticulum...
October 20, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/29052830/diaphragmatic-rupture-a-single-institution-experience-and-literature-review
#7
Carlo Corbellini, Stefano Costa, Tiberio Canini, Roberta Villa, Ettore Contessini Avesani
BACKGROUND: Diaphragmatic rupture (DR) is a rare and potentially life-threatening event caused by trauma or spontaneously. DR occasionally occurs several months after the injury. Chest X-ray and computed tomography are the most effective diagnostic methods. Delay in DR diagnosis occurs frequently. This study aimed to examine and improve our understanding of the etiology, clinical presentation, and management of DR. METHODS: This study was performed at the Emergency and General Surgery Department of Fondazione I...
September 2017: Ulusal Travma Ve Acil Cerrahi Dergisi, Turkish Journal of Trauma & Emergency Surgery: TJTES
https://www.readbyqxmd.com/read/29037794/ventricular-performance-is-associated-with-need-for-extracorporeal-membrane-oxygenation-in-newborns-with-congenital-diaphragmatic-hernia
#8
Gabriel Altit, Shazia Bhombal, Krisa Van Meurs, Theresa A Tacy
OBJECTIVE: To compare echocardiography (ECHO) findings of patients with congenital diaphragmatic hernia (CDH) who required extracorporeal membrane oxygenation (ECMO) to non-ECMO treated patients. STUDY DESIGN: We reviewed clinical and ECHO data of newborns with CDH born between 2009 and 2016. Exclusions included major anomalies, genetic syndromes, or no ECHO prior to ECMO. Pulmonary hypertension was assessed by ductal shunting and tricuspid regurgitant jet. Speckle tracking echocardiography (STE) assessed function by quantifying deformation...
October 13, 2017: Journal of Pediatrics
https://www.readbyqxmd.com/read/29030926/sternal-malformations-and-anesthetic-management
#9
REVIEW
John H Nichols, Viviane G Nasr
Shamberger and Welch classify sternal malformations into four types: thoracic ectopia cordis, cervical ectopia cordis, thoraco-abdominal ectopia cordis, and cleft sternum. Cleft sternum is the most common subset, with a reported incidence of 1 in 50,000 to 100,000 live births, representing 0.15% of all anterior chest wall malformations. Acostello et al further classify cleft sternum into complete or partial (superior, medium, inferior) with a simple superior partial cleft sternum being by far the most common with an orthotopic heart, intact pericardium, and normal skin coverage...
November 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/29030793/right-sided-bochdalek-hernia-in-an-elderly-adult-a-case-report-with-a-review-of-surgical-management
#10
Kazuki Moro, Mikako Kawahara, Yusuke Muneoka, Yu Sato, Chie Kitami, Shigeto Makino, Atsushi Nishimura, Yasuyuki Kawachi, Emmanuel Gabriel, Keiya Nikkuni
BACKGROUND: Bochdalek hernias are one of the most common types of diaphragmatic hernia, with most cases diagnosed during the neonatal period. In contrast, diagnosis of a Bochdalek hernia in an adult is rare and is typically observed on the left side of the diaphragm. Even more rare is the diagnosis of a right-sided Bochdalek hernia in an adult, where there is concurrent visceral malformation in most cases. CASE PRESENTATION: We describe a case of an 89-year-old female who presented with abdominal pain...
October 13, 2017: Surgical Case Reports
https://www.readbyqxmd.com/read/29018962/the-fetal-lung-to-liver-signal-intensity-ratio-on-magnetic-resonance-imaging-as-a-predictor-of-outcomes-from-isolated-congenital-diaphragmatic-hernia
#11
Masaya Yamoto, Teruo Iwazaki, Kasumi Takeuchi, Kyouhei Sano, Koji Fukumoto, Toshiaki Takahashi, Akiyoshi Nomura, Kei Ooyama, Akinori Sekioka, Yutaka Yamada, Naoto Urushihara
PURPOSE: We investigated the developmental changes in the unaffected contralateral lungs of patients with isolated left-sided congenital diaphragmatic hernia (CDH) using signal intensity ratios on prenatal magnetic resonance imaging (MRI) and determined whether these changes correlated with clinical outcomes. METHODS: We performed 47 fetal MRI screens on 30 patients with isolated left-sided CDH. A cohort of 88 fetuses was selected as the control. We calculated the lung-to-liver signal intensity ratio (LLSIR) using region of interest analysis and compared LLSIR between the groups and between those in the CDH group with good and poor prognoses...
October 10, 2017: Pediatric Surgery International
https://www.readbyqxmd.com/read/28932585/an-unusually-large-paraesophageal-hernia-mimicking-a-bochdalek-hernia
#12
Daneish Selvakumar, Karan Sian, Ajay J Iyengar, Ross Mejia
Hiatal hernias are due to defects in the esophageal hiatus in the diaphragm and can be classified into sliding or paraesophageal hernias. A 31-year-old male raised a suspicion of a Bochdalek hernia but at surgery had a large paraesophageal hernia. Bochdalek hernia, a congenital diaphragmatic hernia presents in adulthood asymptomatically or with vague abdominal symptoms. It is paramount to confirm the diagnosis and rule out any fatal complications with imaging studies. Prompt surgical management with large complicated hernias, such as in our case presentation would ensure the most favorable outcome...
August 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28925604/epidemiology-and-prognosis-of-congenital-diaphragmatic-hernia-a-population-based-cohort-study-in-utah
#13
Hari Shanmugam, Luca Brunelli, Lorenzo D Botto, Sergey Krikov, Marcia L Feldkamp
BACKGROUND: Congenital diaphragmatic hernia (CDH) is a relatively frequent and severe malformation. Population-based data on clinical presentation and associated mortality are scarce. We examined a state-wide cohort of infants with a clinically validated diagnosis of CDH to assess their clinical profile, sociodemographic patterns, and infant mortality. METHODS: We identified CDH cases from Utah's statewide population-based surveillance program among the cohort of all pregnancy outcomes (live births, stillbirths, and pregnancy terminations) delivered from 1999 to 2011...
September 19, 2017: Birth defects research
https://www.readbyqxmd.com/read/28922348/stem-cell-biology-and-regenerative-medicine-for-neonatal-lung-diseases
#14
REVIEW
Martin Kang, Bernard Thébaud
Lung diseases remain one of the main causes of morbidity and mortality in neonates. Cell therapy and regenerative medicine have the potential to revolutionize the management of life-threatening and debilitating lung diseases that currently lack effective treatments. Over the past decade, the repair capabilities of stem/progenitor cells have been harnessed to prevent/rescue lung damage in experimental neonatal lung diseases. Mesenchymal stromal cells and amnion epithelial cells exert pleiotropic effects and represent ideal therapeutic cells for bronchopulmonary dysplasia, a multifactorial disease...
October 18, 2017: Pediatric Research
https://www.readbyqxmd.com/read/28876599/a-case-report-of-delayed-presentation-of-a-patient-with-a-ruptured-diaphragm-complicated-by-obstructed-diaphragmatic-hernia-with-gut-gangrene
#15
A Vyas, G Goel
Diaphragmatic rupture is a common occurrence following a major chest trauma and is most commonly associated with road-traffic accidents. Here we report a case of delayed presentation of a 40-year-old man with a ruptured diaphragm with obstruction and bowel infarction, three and a half year following a blunt trauma to chest. This case illustrates how the diagnosis and aggressive management of ruptured diaphragm can be central to life saving and demonstrates the importance of early intervention in cases with features suggestive of compromise of bowel vascularity...
September 2017: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
https://www.readbyqxmd.com/read/28870723/managing-malnourishment-in-pregnancy-after-bariatric-surgery
#16
Rachel K Harrison, Charles Berkelhammer, Victor Suarez, Helen H Kay
BACKGROUND: Little information exists to guide monitoring and treatment of malnourishment during pregnancy after bariatric surgery. Here we present a case with severe deficiencies and recommendations for testing and treatment. CASE: Our patient underwent a duodenal switch procedure resulting in significant weight loss and numerous deficiencies. She then experienced a neonatal demise with multiple congenital abnormalities, including diaphragmatic hernia, possibly related to severe vitamin A deficiency...
September 1, 2017: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
https://www.readbyqxmd.com/read/28868233/intestinal-perforation-during-the-stabilization-period-in-a-preterm-infant-with-congenital-diaphragmatic-hernia
#17
Zbyněk Straňák, Karel Pýcha, Simona Feyereislova, Jaroslav Feyereisl, Michal Rygl
Background  Delayed surgery after stabilization of infants with congenital diaphragmatic hernia (CDH) is an accepted strategy. However, the evidence favoring delayed versus immediate surgical repair is limited. We present an extremely rare case of a very low-birth-weight infant with prenatally diagnosed left-sided CDH and unexpected transmural bowel perforations developing within the postnatal stabilization period. Case Report  A neonate born at 31st week of gestation with a birth weight of 1,470 g with antenatally diagnosed left-sided CDH presented with bowel dilation leading to transmural bowel perforations on the 2nd day of life...
January 2017: European Journal of Pediatric Surgery Reports
https://www.readbyqxmd.com/read/28860014/feasibility-and-safety-of-intact-cord-resuscitation-in-newborn-infants-with-congenital-diaphragmatic-hernia-cdh
#18
Caroline Lefebvre, Thameur Rakza, Nathalie Weslinck, Pascal Vaast, Véronique Houfflin-Debarge, Sébastien Mur, Laurent Storme
BACKGROUND: Starting resuscitation before clamping the umbilical cord at birth may progressively increase pulmonary blood flow while umbilical venous blood flow is still contributing to maintenance of oxygenation and left ventricle preload. OBJECTIVE: To evaluate the feasibility, safety, and effects of intact cord resuscitation (ICR) on cardiorespiratory adaptation at birth in newborn infants with CDH. STUDY DESIGN: Prospective, observational, single-center pilot study...
November 2017: Resuscitation
https://www.readbyqxmd.com/read/28845456/outcome-analysis-of-congenital-diaphragmatic-hernia-cohort-before-and-after-implementation-of-standardized-protocol-in-a-tertiary-neonatal-unit
#19
Amitava Sur, Adjemoke Awoseliya, Alok Sharma
Despite evolving evidence and increased understanding, there is a strong argument that best outcomes in managing congenital diaphragmatic hernia (CDH) patients are achieved in centers which have a high admission rate of such patients and follow standardized operating protocols of management. Pneumothorax and air leak syndromes are one of the main causes of pre- and postoperative morbidity in these patients and experts believe that delivery room sedation and gentle ventilation strategies can minimize this. We observed a significant drop in incidence of pneumothorax and reduction of mortality following implementation of standardized guidelines at the neonatal unit at Southampton which is a tertiary-level neonatal care in the southern United Kingdom and a regional referral center for CDH patients...
July 2017: Surg J (N Y)
https://www.readbyqxmd.com/read/28831761/laparoscopic-repair-of-parahiatal-hernia-after-esophagectomy-a-case-report
#20
Yuji Akiyama, Takeshi Iwaya, Fumitaka Endo, Takehiro Chiba, Takeshi Takahara, Koki Otsuka, Hiroyuki Nitta, Keisuke Koeda, Masaru Mizuno, Yusuke Kimura, Akira Sasaki
BACKGROUND: Diaphragmatic hernia is a potential complication of esophagectomy, which usually occurs as a hiatal hernia and more frequently after minimally invasive esophagectomy. Parahiatal hernia is a rare form of diaphragmatic hernia, and to the best of our knowledge, parahiatal hernia after esophagectomy has not been previously reported. Here, we report a case of parahiatal hernia after esophagectomy that was successfully managed laparoscopically. CASE PRESENTATION: A 73-year-old man underwent thoracoscopic esophagectomy for esophageal cancer with gastric tube reconstruction via the posterior mediastinum...
August 23, 2017: Surgical Case Reports
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