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

Lobar transplantation represents a therapeutic option for children and some adults with severe end-stage pulmonary disease. Six patients including two neonates, three children, and one adult underwent lobar transplantation. Ages ranged from 17 days to 21 years. Transplant procedures were unilateral in the neonates and two of the children and bilateral in the child and adult who had cystic fibrosis. The donor lobes were from cadavers in the two neonates and living related donors in the children and the adult. Unilateral grafts involved use of the right upper lobe in the 12-year-old patient with bronchopulmonary dysplasia; right middle lobe with a ventricular septal defect repair in the 4-year-old patient with Eisenmenger's syndrome, left upper lobe in the 28-day-old patient with primary pulmonary hypertension, and the right upper and middle lobes in the 17-day-old patient with diaphragmatic hernia. Bilateral lobar transplantations were performed with the right lower and left lower lobes in the two patients with cystic fibrosis (aged 13 and 21 years). The two neonates underwent emergency transplantation with the use of extracorporeal membrane oxygenation as a bridge. Perioperative survival was 83%, with only the 4-year-old patient with ventricular septal defect/Eisenmenger's syndrome dying early. No airway complications were observed. The unilateral grafts received most of the blood flow as shown by perfusion scanning (range 74% to 99%). Living related donor complications included prolonged air leaks (> 6 days) in two patients. In urgent situations, such as an infant requiring extracorporeal membrane oxygenation, and in the existing milieu of donor shortage, lobar transplantation (living related or cadaveric) is a surgically feasible procedure and can provide a donor source in the limited time frame of these clinical situations. Bilateral lobe transplantation may be a viable option for patients with cystic fibrosis and life-threatening respiratory decompensation.
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PMID:Lobar transplantation. Indications, technique, and outcome. 807 33

In a retrospective review we analysed alveolar-arterial oxygen difference (AaDO2) as an entry criterion for extracorporeal membrane oxygenation (ECMO) in neonates with several forms of acute respiratory insufficiency. Although for meconium aspiration syndrome, respiratory distress syndrome, sepsis, and idiopathic pulmonary hypertension of the newborn we found values in accordance with the literature, patients with congenital diaphragmatic hernia (CDH) met 80% mortality criteria with significant lower AaDO2 values. Several patients died before ever reaching usual entry criteria for ECMO, because serious lung deterioration makes AaDO2 values unreliable. Awaiting classical ECMO entry criteria for patients with CDH may at least partially explain the lower survival rate for ECMO in CDH.
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PMID:Do we use the right entry criteria for extracorporeal membrane oxygenation in congenital diaphragmatic hernia? 822 83

The charts and cranial ultrasounds of 29 infants treated with extracorporeal membrane oxygenation (ECMO) for respiratory insufficiency secondary to meconium aspiration syndrome, primary pulmonary hypertension, congenital diaphragmatic hernia and/or sepsis were examined to identify ultrasound abnormalities. Seventeen (58.6%) developed extra-axial fluid collections, only two of which were progressive. Ten (34.5%) developed evidence of intracranial hemorrhage (ICH): seven caudate, one each in the thalamus, parietal and occipital lobes. Eight (27.65%) of the neonates had seizures while on ECMO, 5 of whom had concurrent ICH.
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PMID:Ultrasound abnormalities in term infants on ECMO. 832 5

Primary pulmonary hypertension is characterized by the presence of smooth muscle cells in nonmuscular compartments or segments of the vessel and the abnormal deposition of collagen in both the small muscular arteries and arterioles and the large elastic arteries. Victorian blue van Gieson staining and Immunostaining with anti-alpha smooth muscle actin (ASMA) were performed on lung tissues obtained during autopsy from 21 patients who had congenital diaphragmatic hernia (CDH) complicated by persistent pulmonary hypertension (PPH) and 10 control patients who died of sudden infant death syndrome (SIDS). The degree of medial thickening and adventitial thickening was measured in pulmonary arteries by image analysis and compared statistically. There was a significant increase in adventitial as well as medial thickness in arteries of all sizes in CDH patients compared with control patients (P < .001). The most striking increase occurred in arteries with an external diameter (ED) of less than 75 microns. Calculation of the areas of the various components in the wall of each vessel showed that for smaller vessels (< 75 microns ED), the area of the lumen was smaller and the area of the media and adventitia was larger in CDH patients compared with control patients (P < < .001). In vessels greater than 75 microns ED, the areas of media in CDH was the same as in controls and the area of adventitia in CDH was significantly larger than controls (P < .001). The present study provides evidence that an increase in adventitial thickness and adventitial area occurs in pulmonary arteries in CDH patients complicated by PPH. The structural changes in the adventitia of the pulmonary arteries may be an important factor in the development of PPH in patients with CDH.
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PMID:Pulmonary artery structural changes in pulmonary hypertension complicating congenital diaphragmatic hernia. 909 99

Initial trials of partial liquid ventilation (PLV), which is gas ventilation of perfluorocarbon-filled lungs, are underway in patients with severe respiratory failure. We report the first study of the effects of the perfluorocarbon, perflubron, on the lung. Necropsies were conducted in nine patients (seven adults and two neonates; mean adult age, 31 +/- 5 yr) managed with PLV (average number of doses, 4 +/- 1). All of the patients required extracorporeal life support. The patients had pneumonia with the acute respiratory distress syndrome (six patients), trauma/capillary leak syndrome (one patient), congenital diaphragmatic hernia (one patient), and primary pulmonary hypertension (one patient). Nine adult patients (mean age, 37 +/- 5 yr) with acute respiratory distress syndrome requiring extracorporeal life support served as a control. Pathologic findings were evaluated in both groups. Lung weights in the adult patients of both groups were elevated (mean weight of PLV-treated right lung, 1401 +/- 186 g; mean weight of PLV-treated left lung, 1131 +/- 177 g; mean weight of control right lung, 1018 +/- 91 g; mean weight of control left lung, 988 +/- 80 g). There was no significant difference between the two groups (right lung, P = .066; left lung, P = .436). Frequent gross findings included focal consolidation, patchy hemorrhage, and glassy cut surfaces. The histologic findings were similar in both groups. Diffuse alveolar damage (either proliferative phase or mixed proliferative and exudative phases) was seen in all nine of the study patients. Eight of the nine control patients had diffuse alveolar damage (five had proliferative phase only, one had mixed proliferative and exudative phases, and two had exudative phase only). One other patient had extensive parenchymal necrosis. Other frequent findings were intra-alveolar hemorrhage, numerous intra-alveolar macrophages, and organization of exudate. PLV with perflubron in patients with adult and neonatal respiratory distress syndromes is not associated with unique pathologic findings in the human lung.
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PMID:Pulmonary pathology of patients treated with partial liquid ventilation. 916 Mar 11

Severe respiratory failure of the newborn often results in persistent pulmonary hypertension, which is characterized by increased pulmonary vascular resistance, decreased pulmonary blood flow and severe hypoxaemia. Since 3 years inhaled nitric oxide (iNO) has been used as a selective pulmonary vasodilator with variable success in the treatment of persistent pulmonary hypertension. In the present clinical pilot study 10 patients (4 newborns and 6 preterm infants) suffering from severe respiratory failure were treated with iNO. The aim of this study was to evaluate the effectiveness of inhaled NO and to discuss whether or not extracorporeal membrane oxygenation (ECMO) could be delayed or avoided. In all patients oxygenation improved without a decrease in systemic blood pressure. The median OI decreased from 41 to 16.5 during the first 4 hours of treatment and to 12 during the first 12 hours. One patient with congenital diaphragmatic hernia required ECMO therapy and died post operative. One preterm infant with primary pulmonary hypertension died during prolongated hypotension and hypoxemia. iNO may have reduced the need for ECMO which however should be available as an ultimate therapeutic option.
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PMID:[Persistent pulmonary hypertension in premature and newborn infants: selective pulmonary vasodilation with inhaled nitric oxide (iNO)]. 957 19