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

We report the case of a healthy one-month-old male infant who underwent an uneventful endotracheal anaesthetic for hernia repair. During transport to the recovery room (a less than 30 second trip), the endotracheal tube in the spontaneously breathing infant became obstructed, possibly due to impaction of the tip in the right main bronchus. Restoration of the airway was followed by fulminant pulmonary oedema. Several days of vigorous respiratory and pharmacologic therapy were required for resolution of the infant's respiratory distress. We review other reported cases of acute airway obstruction associated with pulmonary oedema in children and briefly describe the proposed mechanisms. The difficulties of gauging proper endotracheal tube depth in the infant are noted. This case report demonstrates the importance of continuous monitoring during patient transport to the recovery room.
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PMID:Negative pressure pulmonary oedema secondary to airway obstruction in an intubated infant. 304 56

Investigation of the composition and significance of individual components of the surfactant indicated that besides phospholipids an important role is played also by surfactant proteins. They aid not only the reduction of the surface tension of the lungs (SP-B, SP-C), but serve also in regulation of surfactant secretion (SP-A) and in local defense and immune responses in the lungs (SP-A and SP-D). Impairments of surfactant were discovered not only in RDS, but also in cases of meconium aspiration, congenital diaphragmatic hernia, pneumonia, pulmonary edema, idiopathic fibrosis of the lungs, alveolar proteinosis, pneumothorax, and bronchial asthma. Therapy by means of exogenous surfactant was proved effective in therapy of RDS. Occasional cases of exogenous surfactant therapy in other pulmonary diseases are auspicious, it is necessary, though, to develop and produce a sufficient amount of exogenous surfactant of high quality and at an acceptable price and to find an optimal manner of surfactant administration into the lungs. A significant perspective is anticipated to utilization of intrapulmonary administration of the exogenous surfactant as a carrier of further active substances for local administration into the lungs. (Ref. 36.)
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PMID:[The pulmonary surfactant factor. Current knowledge, research trends and use in clinical practice]. 788 59

Most cases of acute lung injury in pregnancy are attributed to hydrostatic pulmonary edema. In this report, however, we describe a 20-year-old pregnant woman who developed a unique case of increased permeability pulmonary edema following surgery for the repair of a fetal congenital diaphragmatic hernia. Two days after surgery, the patient developed acute respiratory failure and diffuse alveolar edema, requiring intubation and positive pressure ventilation for 5 days. The diagnosis of increased permeability pulmonary edema was confirmed by the ratio of pulmonary edema fluid to plasma protein (ratio=0.99). The patient received IV nitroglycerine for tocolysis. As a nitric oxide donor, the nitroglycerine may have combined with exogenous oxygen to form peroxynitrite, a known impediment to alveolar epithelial cell function. Many cases of pulmonary edema in pregnancy are diagnosed as hydrostatic based on clinical parameters, such as positive maternal fluid balance. In this case, these parameters would have been misleading. Measurement of the protein concentration in the pulmonary edema fluid allowed us to accurately determine that the patient had increased permeability pulmonary edema as the cause of her acute respiratory failure. Sampling of pulmonary fluid can differentiate the type of edema formation and in some cases help to identify mechanisms of acute lung injury.
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PMID:Pulmonary edema in a woman following fetal surgery. 863 43

Laparoscopic minimally invasive surgical procedures are gaining popularity. Laparoscopic hernia repair is now less controversial and more readily acceptable, with at present numerous technical modifications described in an attempt to define the best procedure. Between November 1992 and February 1995, a nonrandomized trial of laparoscopic inguinal herniorrhaphy was performed on 115 patients with a total of 120 hernias. Of these 58 patients with 60 hernias underwent the transabdominal preperitoneal patch repair (TAPP) without plug and 57 patients with a total of 60 hernias were offered the extraperitoneal (EXTRA) approach using a distension balloon. The average operative time was 55 min for the TAPP and 50 min for the EXTRA procedure. The overall recurrence rate was 1.7% with a follow up of 1-27 months. The recurrence rate was 3.4% for the TAPP and none for the EXTRA approach. All patients returned to their normal activity within 1 week of discharge. Patients undergoing the EXTRA repair consumed less amount of narcotic analgesic than did the group undergoing the TAPP repair. Of the EXTRA group 58% did not require any analgesic, compared to 22% of the TAPP group (p < 05). There were no intraoperative complications. A total of 8 (6.9%) postoperative complications occurred in 115 patients. Four complications (6.9%) occurred in the TAPP procedure: 2 transient urinary retentions, 1 pulmonary edema, and 1 Richter's type hernia. Four (6.9%) complications occurred in the EXTRA procedure: 1 urinary retention, 2 abdominal wall ecchymoses, and 1 thoracic pain. Hospital stay was shorter for the EXTRA group: 57% were discharged the same day and 98% were discharged within 24 h of their operations for the EXTRA group compared to 10 and 84%, respectively, for the TAPP (p < 0.05). Laparoscopic extraperitoneal hernia repair can be accomplished with shorter hospitalization and less analgesic requirement than the TAPP repair. The overall incidence of complications, the recurrence rate, and the return to normal activity were not different between the two types of repair.
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PMID:A comparative study of laparoscopic extraperitoneal and transabdominal preperitoneal herniorrhaphy. 874 85

Anaesthesia was required in an 18-month-old Dorper ewe scheduled for surgical repair of an abdominal hernia. Anaesthesia was induced with diazepam (0.15 mg/kg) and ketamine (6 mg/kg), and maintained with halothane in oxygen on a circle anaesthetic machine. Hypotension, hypoxaemia, cyanosis and pulmonary oedema were observed from the start of surgery, but the symptoms improved towards the completion of the procedure. The aetiology of this condition could not be established. It is suggested that propylene glycol, the organic solvent in the diazepam formulation, may have stimulated the release of vasoactive substances that resulted in pulmonary oedema.
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PMID:Hypoxaemia and suspected pulmonary oedema in a Dorper ewe after diazepam-ketamine induction of anaesthesia. 1094 21

Surfactant has led to a significant reduction in neonatal mortality for premature infants with lung immaturity and respiratory distress. However, surfactant therapy has been shown to be effective in the treatment of a number of other neonatal respiratory disorders and the evidence for surfactant use in such circumstances is presented. Meconium aspiration is characterised by severe atelectasis, the influx of neutrophils, edema, and hyaline membranes, with decreased levels of SP-A and SP-B and the large aggregate fraction of lung surfactant, and altered surfactant surface morphology. Meconium contains cholesterol, free fatty acids and bilirubin all of which can interfere with surfactant function in a dose-dependent fashion. Providing larger amounts of surfactant can overcome some of this inhibition. Animal models of meconium aspiration treated with surfactant have improved histology, lung mechanics and gas exchange. Studies in human infants with meconium aspiration have found elevated concentrations of total protein, albumin, and membrane-derived phospholipid in lung lavage fluid, and haemorrhagic pulmonary edema. Clinical studies in such neonates have reported improved gas exchange and clinical outcomes following surfactant treatment. More recently surfactant lavage has been shown to be a potentially efficacious therapy for such infants. The inflammatory exudate containing plasma proteins and cytokines which accompanies neonatal pneumonia may inactivate surfactant. Surfactant treatment given to animals following the tracheal instillation of group B Streptococcal resulted in significantly less bacterial growth and improved lung function. Small clinical experiences have demonstrated the benefit of surfactant to infants with pneumonia/sepsis. Pulmonary haemorrhage, which some consider a complication of surfactant therapy, has also been effectively managed using surfactant instillation. The hemoglobin and red blood cell lipids may act to inhibit natural surfactant and treatment with surfactant has been shown to improve outcome for infants with pulmonary haemorrhage. Animal models of congenital diaphragmatic hernia (CDH) have hypoplastic lungs with evidence of decreased lamellar bodies in their type II pneumocytes and resultant surfactant deficiency, and respond to surfactant replacement with improved gas exchange and lung mechanics. The lungs of human infants with CDH contain less phospholipids and phosphatidylcholine per milligram of DNA than control infants. Case reports have reported a benefit of surfactant for infants with CDH. In the near-term infants with severe respiratory distress, surfactant is one of the therapies along with inhaled nitric oxide and high frequency ventilations, that have resulted in improved outcomes. Surfactant treatment may be of significant benefit in newborn infants with respiratory compromise secondary to a number of insults, and further prospective evidence of its efficacy in such disorders is needed.
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PMID:Surfactant use for neonatal lung injury: beyond respiratory distress syndrome. 1498 Feb 86

Morgagni-Larrey hernia (MH) is an unusual diaphragmatic hernia of the retrosternal region. Few cases of MH, treated laparoscopically, associated with Down's syndrome (DS) have been reported in literature. On October 2004, a DS 40-year-old male was admitted to our Department with mild abdominal pain and nausea. Hematochemical tests were within the normal range. Ultrasonography showed biliary sludge and multiple gallstones. Chest X-ray revealed a right-sided paracardiac mass that appeared as MH after a thoraco-abdominal computed tomography (CT). Four trocars were placed as a routinary cholecystectomy. Abdominal exploration confirmed the presence of a voluminous hernia through a wide diaphragmatic defect (12 cm) on the left side of the falciform ligament, containing the last 20 cm ileal loops and right colon with the third lateral of transverse. After retrograde cholecystectomy and reduction of the herniated ileo-colonic tract from multiple adherences, the defect was repaired with an interrupted 2/0 silk suture and then a running 2/0 polypropylene suture. Postoperative course was complicated by pulmonary edema but subsequently the patient was discharged without further complications and has no recurrence after 2 years. In conclusion, surgery is necessary for symptomatic MH and to prevent possible severe complications. We preferred laparoscopy for the reduced morbidity compared to laparotomy, even if in our case the postoperative course was not uneventful. There are still few comparative data about the modality of closure of the defect between primary repair with nonabsorbable suture material, in case of small defects, or continuous monofilament suture or prosthesis in case of large defects.
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PMID:Laparoscopic repair of Morgagni hernia and cholecystectomy in a 40-year-old male with Down's sindrome. Report of a case. 1751 46

Extrinsic left atrial compression is an uncommon source of hemodynamic compromise that can be caused by many mediastinal structures including bronchogenic cysts, carcinoma, lymphoma, thymoma, aortic aneurysm and diaphragmatic hernia. We describe an unusual case of a 26-year-old man presenting with symptoms of left heart failure. Transthoracic echocardiography demonstrated extrinsic left atrial compression caused by a metastatic testis non-seminomatous germ cell tumor. Compression of the left atrium caused impaired left atrial filling, leading to pulmonary venous hypertension and pulmonary edema. To our knowledge, the present case is the first reported case of mediastinal metastatic testis non-seminomatous germ cell tumor causing symptoms of left heart failure by externally compressing the left atrium.
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PMID:Mediastinal testicular tumor compressing the left atrium in a young male presenting initially with symptoms of left heart failure. 1918 28

Even a trivial increase in intracranial pressure is likely to induce cerebral ischemia, hernia, and neurogenic pulmonary edema in patients with intracranial hypertension. In this article, I have described several issues that are essential for safe perioperative management in patients undergoing neurosurgical procedures for treatment of subarachonoid hemorrhage, and intracerebral and subdural hematoma, as well as relevant information on basic physiology and pathology of the brain.
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PMID:[Risk management for neurosurgical anesthesia]. 1946 90

Postoperative complications after pneumonectomy, lobectomy, or wedge resection are relatively frequent and potentially significant. Chest radiographs and CT have a crucial role in the early detection and prompt management of these complications. The purpose of this paper is to illustrate the most frequent or severe complications, based on the timing of occurrence. Early complications include bronchopleural fistula, empyema, atelectasis, pneumonia, hemothorax, chylothorax, pulmonary edema, lobar torsion, cardiac hernia, gossypiboma and esophagopleural fistula. Late complications include bronchopleural fistula, esophagopleural fistula, postpneumonectomy syndrome, chest wall arteriovenous fistula and local tumor recurrence.
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PMID:[Postoperative complications after thoracic surgery]. 1975 37


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