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Hernia diafragmatica

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By Alejandro Peñarrieta Daher Residente de Cirugía Pediatrica en Hospital Infantil de México Federico Gómez
Luke R Putnam, Kuojen Tsao, Francesco Morini, Pamela A Lally, Charles C Miller, Kevin P Lally, Matthew T Harting
Importance: Inhaled nitric oxide (iNO) is an expensive, commonly used therapy among patients with congenital diaphragmatic hernia (CDH); however, data to support its ongoing use in this patient population are lacking. Objective: To describe the spectrum of iNO use among patients with CDH and its association with pulmonary hypertension (pHTN) and mortality. Design, Setting, and Participants: A review was conducted of prospectively collected patient data in the Congenital Diaphragmatic Hernia Study Group registry between January 1, 2007, and December 31, 2014, from 70 participating centers in 13 countries...
October 10, 2016: JAMA Pediatrics
Enrico Danzer, Casey Hoffman, Jo Ann D'Agostino, Marsha Gerdes, Judy Bernbaum, Ryan M Antiel, Natalie E Rintoul, Lisa M Herkert, Alan W Flake, N Scott Adzick, Holly L Hedrick
OBJECTIVE: To evaluate neurodevelopmental sequelae in congenital diaphragmatic hernia (CDH) children at 5years of age. MATERIALS AND METHODS: The study cohort of 35 CDH patients was enrolled in our follow-up program between 06/2004 and 09/2014. The neurodevelopmental outcomes assessed at a median of 5years (range, 4-6) included cognition (Wechsler Preschool and Primary Scale of Intelligence [WPPSI], n=35), Visual-Motor-Integration (n=35), academic achievement (Woodcock-Johnson Tests of Achievement, n=25), and behavior problems (Child Behavior Check List [CBCL], n=26)...
August 30, 2016: Journal of Pediatric Surgery
Masaya Yamoto, Noboru Inamura, Keita Terui, Kouji Nagata, Yutaka Kanamori, Masahiro Hayakawa, Yuko Tazuke, Akiko Yokoi, Hajime Takayasu, Hiroomi Okuyama, Koji Fukumoto, Naoto Urushihara, Tomoaki Taguchi, Noriaki Usui
BACKGROUND/PURPOSE: The purpose of this study was to investigate echocardiographic parameters in relation to the outcomes of isolated left-sided congenital diaphragmatic hernia (CDH). METHODS: This multicenter, retrospective, observational study was conducted among patients with CDH born between 2006 and 2010. Patients in this study did not have severe cardiac malformations or chromosomal aberrations. Patients with incomplete echocardiographic examinations were excluded...
September 15, 2016: Journal of Pediatric Surgery
Kevin P Lally, William Engle
Infants with congenital diaphragmatic hernia often require intensive treatment after birth, have prolonged hospitalizations, and have other congenital anomalies. After discharge from the hospital, they may have long-term sequelae such as respiratory insufficiency, gastroesophageal reflux, poor growth, neurodevelopmental delay, behavior problems, hearing loss, hernia recurrence, and orthopedic deformities. Structured follow-up for these patients facilitates early recognition and treatment of these complications...
March 2008: Pediatrics
David W Kays, James L Talbert, Saleem Islam, Shawn D Larson, Janice A Taylor, Joy Perkins
BACKGROUND: Delayed repair of congenital diaphragmatic hernia (CDH) for days or longer has become standard, allowing improved stabilization for many, but potentially complicating treatment in severely affected infants who require extracorporeal membrane oxygenation (ECMO) and arrive unrepaired. Survival in left liver-up CDH, the most severe anatomic subset, averages 45% in published studies, with deaths often occurring in patients who failed to improve on ECMO and are repaired late, or not at all...
April 2016: Journal of the American College of Surgeons
David W Kays, Saleem Islam, Joy M Perkins, Shawn D Larson, Janice A Taylor, James L Talbert
PURPOSE: Centers that care for newborns with congenital diaphragmatic hernia (CDH) may impose selection criteria for offering or limiting aggressive support in those patients most severely affected. The purpose of this study was to analyze outcomes in newborns with highly severe CDH uniformly treated for survival. METHODS: We reviewed 172 consecutive inborn patients without associated lethal anomalies treated at a single institution with a dedicated CDH program...
June 2015: Journal of Pediatric Surgery
C Gregoir, A C Engels, O Gomez, P DeKoninck, L Lewi, E Gratacos, J A Deprest
STUDY QUESTION: What is the impact of fetoscopic surgery for isolated Congenital Diaphragmatic Hernia (CDH) on future reproductive and gynecological outcomes? SUMMARY ANSWER: We did not observe an increase of obstetric or gynecological problems after fetoscopic surgery nor was there an increased risk for subsequent infertility. WHAT IS KNOWN ALREADY: The reproductive and gynecological outcomes of patients undergoing open maternal-fetal surgery are known...
September 2016: Human Reproduction
Jason Gien, John P Kinsella
OBJECTIVE: To determine whether right-to-left shunting across the ductus arteriosus (DA) in patients with congenital diaphragmatic hernia (CDH) with suprasystemic pulmonary hypertension (PH) results in differences between preductal and postductal arterial blood gas (ABG) measurements. DESIGN: Demographics, baseline echocardiographic parameters and differences in simultaneous right upper extremity (preductal) and umbilical artery (postductal) ABG samples were determined in newborns with PH and CDH...
July 2016: Archives of Disease in Childhood. Fetal and Neonatal Edition
Carmen Mesas Burgos, Erik G Pearson, Marcus Davey, John Riley, Huimin Jia, Pablo Laje, Alan W Flake, William H Peranteau
BACKGROUND: Pulmonary hypoplasia and hypertension is a leading cause of morbidity and mortality in congenital diaphragmatic hernia (CDH). The etiologic insult occurs early in gestation highlighting the potential of prenatal interventions. We evaluated prenatal pharmacologic therapies in the nitrofen CDH model. METHODS: Olive oil or nitrofen were administered alone or with dexamethasone (DM), sildenafil, or DM+sildenafil to pregnant rats. Newborn pups were assessed for lung function, structure and pulmonary artery (PA) flow and resistance...
October 2016: Pediatric Research
Michael Collin, Sarah Trinder, Corrado Minutillo, Shripada Rao, Jan Dickinson, Naeem Samnakay
BACKGROUND/PURPOSE: This study aims to retrospectively review outcomes, including neurodevelopmental outcomes, of neonatal right sided congenital diaphragmatic hernias (RCDH) compared with left sided congenital diaphragmatic hernias (L-CDH) treated surgically at our institute. METHODS: A retrospective review was undertaken of all cases of congenital diaphragmatic hernia (CDH) treated at Princess Margaret Hospital for Children (PMH), Perth, born between 1st January 2002 and 1st August 2012...
September 2016: Journal of Pediatric Surgery
Emily A Partridge, William H Peranteau, Lisa Herkert, Norma Rendon, Haylee Smith, Natalie E Rintoul, Alan W Flake, N Scott Adzick, Holly L Hedrick
PURPOSE: Right-sided congenital diaphragmatic hernia (R-CDH) occurs in up to 25% of all CDH cases, but has been less widely studied compared to left-sided defects. We sought to compare characteristics and outcomes of left- versus right-sided defects in a large cohort of CDH patients who underwent standardized treatment and follow-up at a single institution. METHODS: We retrospectively reviewed charts of all CDH patients in our pulmonary hypoplasia program from January 2002 through December 2014...
June 2016: Journal of Pediatric Surgery
Jason C Fisher, Rashida A Jefferson, Marc S Arkovitz, Charles J H Stolar
PURPOSE: Available data comparing the management and outcome of right-sided (R-CDH) vs left-sided congenital diaphragmatic hernia (L-CDH) are inconsistent. Large-volume CDH studies are limited by small numbers of R-CDH or are confounded by compilations from multiple institutions with multiple treatment strategies. Consequently, they are underpowered to draw conclusions. To define the behavior and outcomes of R-CDH better, we report the largest single-institution series of R-CDH and ask if factors traditionally linked to poor prognosis in L-CDH were applicable to R-CDH...
February 2008: Journal of Pediatric Surgery
F A Byrne, R L Keller, J Meadows, D Miniati, M M Brook, N H Silverman, A J Moon-Grady
OBJECTIVES: To assess whether severity of congenital diaphragmatic hernia (CDH) correlates with the degree of left heart hypoplasia and left ventricle (LV) output, and to determine if factors leading to abnormal fetal hemodynamics, such as compression and reduced LV preload, contribute to left heart hypoplasia. METHODS: This was a retrospective cross-sectional study of fetuses at 16-37 weeks' gestation that were diagnosed with CDH between 2000 and 2010. Lung-to-head ratio (LHR), liver position and side of the hernia were determined from stored ultrasound images...
December 2015: Ultrasound in Obstetrics & Gynecology
Alejandro V Garcia, Abbey L Fingeret, Arul S Thirumoorthi, Eunice Hahn, Matthew J Leskowitz, Gudrun Aspelund, Usha S Krishnan, Charles J H Stolar
PURPOSE: Lung-to-head ratio (LHR) has been used for antenatal evaluation of infants with congenital diaphragmatic hernia (CDH). We hypothesized that LHR was predictive of acute and chronic pulmonary hypertension in infants with CDH. METHODS: Echocardiograms on all inborn infants with CDH (December 2001-March 2011) were reviewed. Echocardiograms at 1 and 3 months post-repair and most recent follow-up were assessed for presence of pulmonary hypertension (PAH). LHR, gestational age, birth weight, extracorporeal membrane oxygenation (ECMO), and death rate were obtained...
January 2013: Journal of Pediatric Surgery
Julia Wynn, Usha Krishnan, Gudrun Aspelund, Yuan Zhang, Jimmy Duong, Charles J H Stolar, Eunice Hahn, John Pietsch, Dai Chung, Donald Moore, Eric Austin, George Mychaliska, Robert Gajarski, Yen-Lim Foong, Erik Michelfelder, Douglas Potolka, Brian Bucher, Brad Warner, Mark Grady, Ken Azarow, Scott E Fletcher, Shelby Kutty, Jeff Delaney, Timothy Crombleholme, Erika Rosenzweig, Wendy Chung, Marc S Arkovitz
OBJECTIVE: To identify clinical factors associated with pulmonary hypertension (PH) and mortality in patients with congenital diaphragmatic hernia (CDH). STUDY DESIGN: A prospective cohort of neonates with a diaphragm defect identified at 1 of 7 collaborating medical centers was studied. Echocardiograms were performed at 1 month and 3 months of age and analyzed at a central core by 2 cardiologists independently. Degree of PH and survival were tested for association with clinical variables using Fischer exact test, χ(2), and regression analysis...
July 2013: Journal of Pediatrics
Gudrun Aspelund, Jason C Fisher, Lynn L Simpson, Charles J H Stolar
OBJECTIVE: The literature suggests that lung-head ratio (LHR) and liver position may inconsistently predict outcome for congenital diaphragmatic hernia (CDH). We reviewed our inborn neonates with isolated left-sided CDH to determine whether these variables predicted survival and to estimate the optimal LHR threshold. METHODS: Prenatal LHR and liver position were obtained from 2002 to 2009. The primary endpoint was survival. RESULTS: LHR was greater in survivors after adjusting for gestational age (median 1...
July 2012: Journal of Maternal-fetal & Neonatal Medicine
Jeffrey W Gander, Jason C Fisher, Erica R Gross, Ari R Reichstein, Robert A Cowles, Gudrun Aspelund, Charles J H Stolar, Keith A Kuenzler
INTRODUCTION: Experience in thoracoscopic congenital diaphragmatic hernia (CDH) repair has expanded, yet efficacy equal to that of open repair has not been demonstrated. In spite of reports suggesting higher recurrent hernia rates after thoracoscopic repair, this approach has widely been adopted into practice. We report a large, single institutional experience with thoracoscopic CDH repair with special attention to recurrent hernia rates. METHODS: We reviewed the records of neonates with unilateral CDH repaired between January 2006 and February 2010 at Morgan Stanley Children's Hospital...
July 2011: Journal of Pediatric Surgery
Anastassios C Koumbourlis, Jen Tien Wung, Charles J Stolar
BACKGROUND/PURPOSE: Congenital diaphragmatic hernia (CDH) is initially characterized by severe restrictive lung defect and low lung compliance, but survivors have relatively few abnormalities later in life. We studied the changes in lung growth and function in infants after the repair of CDH. METHODS: Retrospective analysis of pulmonary function tests was performed during the first 24 months of life in 56 infants (33 male and 23 female) after repair of CDH. Lung function (functional residual capacity [FRC], respiratory system compliance [C(rs)] and resistance [R(rs)], and maximum expiratory flow rate at FRC [V'(maxFRC)]) were compared among 4 different ages (0-3, 4-6, 7-12, and 13-24 months)...
October 2006: Journal of Pediatric Surgery
J W Logan, H E Rice, R N Goldberg, C M Cotten
OBJECTIVES: Recent reports suggest that specific care strategies improve survival of infants with congenital diaphragmatic hernia (CDH). This review presents details of care from centers reporting high rates of survival among CDH infants. STUDY DESIGN: We conducted a MEDLINE search (1995 to 2006) and searched all citations in the Cochrane Central Register of Controlled Trials. Studies were included if they contained reports of >20 infants with symptomatic CDH, and >75% survival of isolated CDH...
September 2007: Journal of Perinatology: Official Journal of the California Perinatal Association
Judd Boloker, David A Bateman, Jen-Tien Wung, Charles J h Stolar
BACKGROUND/PURPOSE: Poor prognosis (approximately 50% survival rate and significant morbidity) traditionally has been associated with congenital diaphragmatic hernia (CDH). The authors reviewed a single institution experience and challenged conventional wisdom in the context of a care strategy based on permissive hypercapnea/spontaneous respiration/elective repair. METHODS: From August 1992 through February 2000, all infants with CDH and (1) respiratory distress requiring mechanical ventilation, (2) in-born or (3) transferred preoperatively within hours of birth are reported...
March 2002: Journal of Pediatric Surgery
2016-05-02 13:39:59
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