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

Delayed herniation of abdominal contents through a congenital diaphragmatic hernia may occur beyond the neonatal period. The case of a 29-month-old child with a Bochdalek hernia presenting as acute respiratory failure is presented. Chest radiography showed a tension gastrothorax that was misread as a tension pneumothorax. Tube thoracostomy resulted in clinical improvement by perforating and decompressing the stomach. Nasogastric tube placement confirmed herniation of the stomach into the left chest and is the initial treatment of choice when a tension gastrothorax is identified. A congenital diaphragmatic hernia must be recognized promptly so that rapid gastric decompression and surgical repair of the diaphragmatic defect can be performed.
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PMID:Congenital diaphragmatic hernia presenting as massive gastrothorax. 233 Nov 2

Fifty-three neonates and seven pediatric patients were treated with extracorporeal membrane oxygenation from September 1983 until April 1986. Venoarterial bypass was achieved by cannulating the right atrium via the right internal jugular vein and the aortic arch via the right common carotid artery. In the neonatal group, 40 infants with acute respiratory failure were treated, and 36 (90%) survived. Five infants with congenital heart disease were treated and three (60%) survived. Among the eight patients with congenital diaphragmatic hernia, there were three (38%) survivors. In the pediatric group, four patients were treated for ventricular failure after cardiac operations. Two were weaned from bypass, with one long-term survivor. Three patients with acute respiratory failure were treated, with one survivor. salvaging high-risk neonates with minimal morbidity and mortality. It has also been useful in the support of infants with congenital heart disease and congenital diaphragmatic hernia. In pediatric patients one cannot expect to get results that are comparable to those found in neonates. Still, this modality can be useful in salvaging some moribund patients with pulmonary or cardiac failure, or both.
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PMID:Extracorporeal membrane oxygenation for respiratory and cardiac failure in infants and children. 380 95

We report a case of Bochdalek's hernia with volvulus of the stomach and extrapulmonary sequestration in an adult. A 27-year-old woman presented acute respiratory failure, pain in the left side of the chest and recurrent vomiting of sudden onset. Upon examination there was pain in the left hypochondrium that was not tolerated in decubitus position. A chest film showed an "arch" at the base on the left side and an upper gastrointestinal series revealed volvulus of the stomach. After a left thoracotomy, the stomach, spleen and greater omentum were found displaced into the thoracic cavity. After the viscera were confined to the abdomen, the hernia was repaired and the pulmonary sequestration was removed. Two years later, the patient was asymptomatic and a chest film was normal.
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PMID:[Bochdalek's hernia in an adult with stomach volvulus and extrapulmonary sequestration]. 762 24

Acute respiratory failure (ARF) secondary to congenital diaphragmatic hernia (CDH), unresponsive to maximal medical management, has traditionally been treated with venoarterial (VA) extracorporeal membrane oxygenation (ECMO). Venovenous (VV) ECMO offers several benefits over VA ECMO including preserved pulmonary blood flow, preservation of the carotid artery, and pulsatile flow. However, use of the VV modality has not been widespread because of concerns of the cardiac instability during bypass, and because only one double-lumen (DL) catheter size is available in the United States. The authors hypothesize that VV ECMO is a safe and effective treatment for CDH, symptomatic at birth, and report a single institution experience of preferential VV use for CDH. Over an 18-month period, 14 patients with CDH were placed on ECMO after maximal medical management failed, including high-frequency ventilation and nitric oxide in some cases. Ability to place the 14 Fr DL catheter was the sole criteria for VA or VV selection. Nine patients were successfully placed on VV and 5 on VA; no VV patient required conversion to VA. The two groups of patients were similar with respect to degree of illness, birth weight, EGA, time on and age at start of ECMO. Overall survival for this series was 64%: 66% in the VV group and 60% in the VA group. Two patients in the VV group were found to have congenital heart disease incompatible with life, were withdrawn from therapy and allowed to die, and are listed as treatment failures. The authors conclude that CDH patients receive adequate oxygenation and show hemodynamic stability on VV ECMO.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Preferential use of venovenous extracorporeal membrane oxygenation for congenital diaphragmatic hernia. 776 Feb 33

The surgical repair of giant hernias is a serious problem. To return the viscera that are contained within the hernia sac, to the abdominal cavity, we can cause an increase of abdominal pressure, that influences the motion of the diaphragm. In fact, post-operative acute respiratory failure is always possible, in these patients. To have a good operation, the preoperative preparation by physiotherapy is very important, it helps the patient to utilize at most his pulmonary capacity. In the surgical repair of these cases, it is necessary to increase the volume of the abdominal cavity by some different techniques, in order that the intra-abdominal pressure does not increase too much. The reabsorbable prosthesis is placed in direct contact with viscera and fixed to the peritoneum and posterior rectus sheaths, so that it allows to increase the volume of the abdominal cavity. Dacron mesh is fixed to fascia and muscles and assures a long-time contentitive function. To choose the right operation depends on every single case, so the techniques are different and they often can not be codified. In the text there are described three complicated cases and the surgical repair that has been used. The last case describes a personal techniques that uses two prosthesis to create a new peritoneal cavity and a new pre-peritoneal space. The results obtained let us say that the surgery which has a functional base and the alloplastic prostheses have permitted to operate some clinical cases very difficult.
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PMID:[Complicated extremely large hernias. The technical problems]. 835 44

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

Inhaled nitric oxide (iNO) has been shown to improve oxygenation in severe persistent pulmonary hypertension of the newborn (PPHN). However, PPHN is often associated with various lung diseases. Thus, response to iNO may depend upon the aetiology of neonatal acute respiratory failure. A total of 150 (29 preterm and 121 term) newborns with PPHN were prospectively enrolled on the basis of oxygenation index (OI) higher than 30 and 40, respectively. NO dosage was stepwise increased (10-80 ppm) during conventional mechanical or high-frequency oscillatory ventilation while monitoring the oxygenation. Effective dosages ranged from 5 to 20 ppm in the responders, whereas iNO levels were unsuccessfully increased up to 80 ppm in the nonresponders. Within 30 min of iNO therapy, OI was significantly reduced in either preterm neonates (51+/-21 vs 23+/-17, P < .0001) or term infants with idiopathic or acute respiratory distress syndrome (45+/-20 vs 20+/-17, P < .0001), 'idiopathic' PPHN (39+/-14 vs 14+/-9, P < .0001), and sepsis (55+/-25 vs 26+/-20, P < .0001) provided there was no associated refractory shock. Improvement in oxygenation was less significant and sustained (OI=41+/-16 vs 28+/-18, P < .001) in term neonates with meconium aspiration syndrome and much less (OI=58+/-25 vs 46+/-32, P < .01) in those with congenital diaphragmatic hernia. Only 21 of the 129 term newborns (16%) required extracorporeal membrane oxygenation (57% survival). Survival was significantly associated with the magnitude in the reduction in OI at 30 min of iNO therapy, a gestational age > or =34 weeks, and associated diagnosis other than congenital diaphragmatic hernia. Conclusion, iNO improves the oxygenation in most newborns with severe hypoxaemic respiratory failure including preterm neonates. However, response to iNO is disease-specific. Furthermore, iNO when combined with adequate alveolar recruitment and limited barotrauma using exogenous surfactant and HFOV may obviate the need for extracorporeal membrane oxygenation in many term infants.
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PMID:Disease-related response to inhaled nitric oxide in newborns with severe hypoxaemic respiratory failure. French Paediatric Study Group of Inhaled NO. 977 35

ECMO (extracorporeal membrane oxygenation) involves long term treatment in a modified heart lung machine. It is used in the treatment of patients with extremely severe, acute respiratory distress in order to provide gas exchange through an extracorporeal artificial oxygenator. From 1987 until March 2003, 200 patients have been treated in this center. 104 were neonates, 50 older children and 46 adults. Meconium aspiration syndrome and congenital diaphragmatic hernia were the most common diagnoses among neonates, whereas pneumonia was the most frequent in older children and adults. In total 140 patients (70 per cent) survived until discharge or referral. The survival rate was higher among neonates (80 per cent) than older children (54 per cent) and adults (65 per cent). ECMO has been concluded to be life saving in selected cases of extremely severe acute respiratory failure.
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PMID:[Swedish experiences with ECMO--treatment with an artificial lung]. 1510 Dec 13

A young adult presented with signs of peritonitis following tube thoracostomy for suspected acute hydropneumothorax. Attempted decompression of the chest by tube thoracostomy had caused gastric perforation, and on surgical exploration, he was found to have a congenital diaphragmatic hernia with herniation of the stomach, spleen and colon. All intensive care doctors and emergency room physicians dealing with the care of patients with acute respiratory failure should be taught to recognize and keep the possibility of a Bochdalek hernia in mind, especially in young adults presenting with unusual respiratory and gastrointestinal symptoms.
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PMID:Peri-operative course of peritonitis following tube thoracostomy: A misdiagnosed case of congenital diaphragmatic hernia. 2588 8

Patients with chronic obstructive pulmonary disease (COPD) are at increased risk for perioperative complications. The frequency of complications depends on the severity of COPD, the type of anesthesia used, the surgical site, and other comorbidities. Patients undergoing upper abdominal surgery have significant changes in lung volumes, likely secondary to changes in diaphragm function and abdominal pain, and these changes increase the risk for complications, including acute respiratory failure, atelectasis, pneumonia and unplanned reintubation. We discuss a patient with COPD who did well for the first 3 days following an open incisional hernia repair. However, on the fourth day he noted significant dyspnea and radiographic studies revealed atelectasis. Over the next week the patient remained symptomatic and dependent on noninvasive ventilation; he eventually had a rapid response to corticosteroids. This case indicates that atelectasis can develop late following a surgical procedure and that multiple factors potentially influence development of this complication.
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PMID:Delayed Respiratory Distress in a Patient With Chronic Obstructive Pulmonary Disease After Abdominal Surgery. 3133 53


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