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Query: UMLS:C0019270 (hernia)
 15,856 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We present a case of rupture of the right diaphragm, due to an automobile accident, discovered after a period of eight years and presenting a clinical picture of pleuropneumonia. The radiologic appearances of traumatic hernia of the diaphragm are more difficult to appreciate on the right side because of the presence of the liver and delayed symptoms. This may be dangerous or sometimes fatal.
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PMID:Traumatic rupture of right diaphragm presenting as pleuropneumonia. 96 46

Thirty-two thoracoscopies were performed in 28 horses. Sixteen horses were affected with pleuropneumonia whereas 12 were affected with various other thoracic conditions. The indications for thoracoscopy was diagnostic in 19 cases, therapeutic in 11 cases and both diagnostic and therapeutic in 2 cases. Twenty-six thoracoscopies were done standing whereas 6 were performed under general anaesthesia. The specific procedures performed during thoracoscopy were exploratory only (7), biopsy of the lung and lymph nodes (10), drain placement into pleural effusions (2) and abscesses (5), exploration prior to thoracotomy (2), transection of pleural adhesions and decortication (1) and window pericardectomy (2). Diaphragmatic hernia repair (2) and partial pneumonectomy (1) were initiated thoracoscopically but conversion to thoracotomy was necessary for completion. Standing thoracoscopy was well tolerated in most horses. Transient exacerbation of pulmonary compromise evidenced by tachypnoea was readily alleviated by reinflation of the lung. Standing thoracoscopy provided good visualisation of the dorsal and lateral structures of the thorax. The ventral thoracic structures and the cranial ventral diaphragmatic surfaces of the lungs were best visualised in dorsal or lateral recumbency under general anaesthesia. Thoracoscopy is a safe and useful diagnostic and therapeutic tool in horses with thoracic diseases.
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PMID:Thoracoscopy in the horse: diagnostic and therapeutic indications in 28 cases. 984 64

We described herein a case of the fulminant form of acute disseminated encephalomyelitis (ADEM) that developed after mycoplasma pneumonia. A 28-year-old man who presented with fever, headache, and writing difficulty was admitted to our hospital in August 1997. He developed hernia on the 3rd hospital day. Surgical decompression and intravenous prednisolone failed to halt his progressive deterioration. We introduced systemic hypothermia and he has shown marked recovery; despite having Broca's type aphasia, he could comprehend spoken language and communicate with others by gesture. Head MRI demonstrated diffuse high signals over the white matter on fluid attenuated inversion recovery (FLAIR) images, which suggested extensive demyelination. The clinical course, imaging studies and presence of polymorphonuclear dominant leucocytosis in the blood and CSF in the patient are somewhat similar to findings in acute hemorrhagic leukoencephalitis, however, the result of a brain biopsy was inconclusive. The fulminant form of ADEM is usually fatal. Treatments such as corticosteroids, intravenous immunoglobulin, and surgical decompression have been performed to improve the prognosis. Our case results indicate that hypothermia, which suppresses both brain edema and immune response, may be included in the repertoire of treatment for the fulminant form of ADEM.
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PMID:Fulminant form of acute disseminated encephalomyelitis: successful treatment with hypothermia. 1042 55

A case of an 11-month-old infant with a delayed presentation of congenital diaphragmatic hernia is reported. Incarceration of the herniated colon caused a misleading appearance on the chest X-ray which was interpreted as massive pleuropneumonia. Computed tomography, performed because of continuing deterioration in the clinical condition, showed fluid-filled bowel loops in the chest and dilated bowel loops with air-fluid levels in the abdomen, suggesting the correct diagnosis.
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PMID:CT diagnosis of delayed presentation of congenital diaphragmatic hernia simulating massive pleuropneumonia. 1052 88

The incidence of congenital diaphragmatic hernia (CDH) is about 4.8/10,000 live births. Its typical clinical presentation is respiratory distress occurring immediately after birth or in the first few hours or days of a child's life. It is characterized by a high mortality rate. Exceptionally, CDH can occur at an older age, its symptoms then frequently reflecting gastrointestinal obstruction or mild respiratory symptoms. In such cases CDH presents a far more complex diagnostic problem. The paper presents the cases of two girls without typical symptomatology, aged 5.5 and 10 years, in whom CDH was detected incidentally upon thorough physical examination and chest x-rays. Further radiographic evaluation, which included barium contrast study and spiral computed tomography, confirmed the suspicion of a left-sided posterolateral diaphragmatic hernia with associated intestinal malrotation. Surgical intervention conclusively confirmed a diaphragmatic defect at the site of Bochdalek's foramen in both cases. The vital capacity of the older girl, which was low before the surgery (VC 1.66 L; 69% of predicted), was significantly increased a month after the surgical treatment (VC 2.25 L; 92% of predicted). The generally expressed view that the clinical onset of CDH is rare after the neonatal period seems to be erroneous. Some papers report on the clinical presentation of CDH after the neonatal period in as many as 13%-14% of infants and young children suffering from CDH. Infants and young children with a delayed clinical occurrence of CDH can present with respiratory or gastrointestinal symptomatology. Children presenting with gastrointestinal symptoms have been shown to be significantly older than those presenting with respiratory symptoms. In older children and adolescents, the symptoms and signs of CDH, which include acute hernial incarceration, nausea, recurrent vomiting, diarrhea, obstipation, acute gastric dilatation, subcostal pain, failure to thrive and recurrent chest infections, habitually present a significant diagnostic problem. Diagnostic errors are mainly due to the fact that the possibility of CDH in that age is totally neglected. The most recurrent diagnostic misinterpretations in such cases are pneumonia or massive pleuropneumonia, empyema, pneumothorax, lung cysts and bullae, and gastric volvulus. Thus, whenever a child presents with uncommon respiratory or gastrointestinal symptoms and an anomalous chest x-ray, a differential diagnosis of CDH should be considered. Otherwise, an accurate diagnosis in both young and older children will most probably be only reached at autopsy. In conclusion, the presented cases corroborate the finding that CDH in older children may present with scarce symptoms, mostly gastrointestinal, or may be altogether asymptomatic and unrecognized until as late as adolescence. However, when a diagnosis of CDH has been established, albeit asymptomatic, it must be promptly treated surgically in order to prevent complications, such as strangulation or bowel perforation, and thus avert a potentially fatal outcome. The size itself of the herniac foramen is unlikely to be a determining factor at the time of clinical presentation of CDH. Surgical occlusion of CDH may in older children result in an improved vital capacity, as such cases are rarely associated with major pulmonary hypoplasia. Complications resulting from surgical treatment of CDH in older children are more likely to occur in the gastrointestinal system, as a consequence of the associated bowel malrotation and inadequate bowel fixation. Finally, these two cases corroborate the diagnostic value of accurate history taking and thorough physical examination.
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PMID:[Congenital diaphragmatic hernia in older children]. 1550 87