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

The mortality of children with posterolateral diaphragmatic hernia (PDH) is mainly dependent upon the degree of lung hypoplasia. Other less significant factors are dysmaturity, associated anomalies, infection and haemorrhages. Children with grave cyanosis from PDH immediately after birth have a poor prognosis due to persistent foetal circulation with pulmonary vascular hypertension and right-left shunting. A better understanding and treatment of this persistent foetal circulation may considerably improve the surgical mortality, though in some cases the lung hypoplasia may be too far advanced.
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PMID:Postoperative causes of death in pediatric surgery: analysis and conclusions for the therapy. 52 54

The aetiology of congenital lobar emphysema is not always evident. In the group with demonstrable check-valve mechanism, which allows the air to enter but not to leave the lung, there is either internal stenosis or external compression of the bronchus. When no cause can be found, the condition is called idiopathic, although in some cases alveolar fibrosis has been demonstrated, the check-valve mechanism being in these cases at an alveolar level. In the small group of rare cases of bronchial atresia, air which enters through a collateral ventilation cannot be removed by the same route; in these case too, the check-valve mechanism exists at the alveolar level. Five cases of "congenital lobar emphysema" are presented. One case showed no bronchial anomaly; another case showed an increase in interstitial connective tissue in the lung; tow cases showed hypoplasia or absence of bronchial cartilage; in one case, bronchial atresia was found at operation. Infants show a typical symptomatology of dyspnoea and cyanosis, and a typical chest X-ray with unilateral radiolucency and a delicate lung pattern, collapse of surrounding lung tissue, and mediastinal hernia. In older children, the diagnosis is made either incidently or following a complication. The condition is usually found in the left upper and the right middle lobe. Treatment is surgical and consists of resection of the emphysematous segments.
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PMID:Congenital lobar emphysema. 86 84

Eighty-four cases of posterolateral diaphragmatic hernia in children are reviewed. The most frequent signs were respiratory insufficiency, cyanosis and costal indrawing. The diagnosis was clinically established in over one half of the cases. In most of the patients, the studies showed respiratory acidosis. Also, radiological studies showed, in most of the cases, elevation of the hemidiaphragm with basal opacity of the hemithorax. For surgical treatment, the choice route was the abdominal. Overall mortality reached 37%.
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PMID:[Congenital posterolateral diaphragmatic hernia]. 124 82

Extracorporeal membrane oxygenation (ECMO) provides an adjunct to support of neonates with respiratory distress. The rate of venous drainage is the limiting step to the amount of arterial flow that may be generated during ECMO. We present a 3-kg, 37-week gestation female with congenital diaphragmatic hernia (CDH) whose anatomic venous drainage was insufficient to allow total extracorporeal support. The internal jugular vein was of insufficient size to allow placement of a cannula large enough to support adequate bypass flow. We established minimally acceptable flow by simultaneous caudad and cephalad catheterization of the internal vein. We performed a right lower quadrant retroperitoneal dissection and cannulated the common iliac vein when systemic pressures deteriorated at 24 hours with marginal venous drainage. After triple cannulation the bypass flows were normal. The right leg developed mild cyanosis and edema immediately following cannulation, but these changes resolved over 24 hours with elevation. The common iliac vein provides a desirable route for augmentation of venous drainage in the patient with difficult standard, or cephalad, jugular venous access for extracorporeal support.
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PMID:Augmented venous access in the problematic ECMO patient: a case report. 152 74

Congenital diaphragmatic hernia is one of the acute pediatric surgical emergencies and an important cause of perinatal mortality. Its incidence varies from 1 in 2000 to 1 in 5000 live-births, with a greater incidence in stillbirths and abortions. Non-operative mortality is generally reported as 100% and early diagnosis is imperative. A retrospective study of all infant and neonatal autopsies done during last 30 years (1960 to 1989) was conducted. Ten cases of congenital diaphragmatic hernia were encountered among 588 autopsies and its incidence was 1.7% of all infant and neonatal autopsies, dying due to varying causes. The male:female ratio was 7:3, while maternal factors showed no consistent relationship. All cases had left-sided posterolateral diaphragmatic defects. Dyspnea, cyanosis and dextrocardia was the classical triad present in more than 50% cases. The commonest herniated contents were the small intestinal loops and the left lobe of liver. Associated congenital multiple anomalies related to neural axis, skull, vertebral column and cardiovascular system were noted in 30% cases and were major contributory factors for perinatal mortality.
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PMID:Congenital diaphragmatic hernia: a retrospective autopsy study. 175 77

Asphyxiating thoracic dystrophy (ATD) is a rare case of autosomal recessive disease. We report a case of full term female infant, who was noted to have small chest cage with severe respiratory distress soon after birth. On physical examination. The chest wall was fixed and small with the narrowest circumference about 29 cm in size, general cyanosis and distended abdomen were noted, there was a umbilical hernia around 1 cm in diameter. Otherwise, no other gross anomalies were found. Radiologic studies revealed short and horizontal ribs, small lung volume but depressed diaphragm, the clavicles and the spine were normal. The abdomen and long bone series all showed negative findings. The patient died of respiratory failure at 18 hours after birth. Autopsy was documented as a case of ATD. According to family history, there was one sibling die in the similar condition, although no autopsy available. Because the disease is transmitted as autosomal recessive trait, so 25% of next sibling will get the same condition. Therefore genetic consulting is necessary.
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PMID:[Asphyxiating thoracic dystrophy: a case report]. 217 59

A 2,980-gram female infant was born to a 25-year-old mother at the gestational age of 34 weeks with the chief problems of asphyxia and respiratory distress. Prenatal sonogram at 34th week of gestation showed significant pleural effusion, mediastinal shift, polyhydramnios and large for date. Soon after birth, she was put on intubation and ventilator therapy. Physical examination revealed poor chest wall excursion. Breathing sound was markedly decreased over the right lung field. Abdomen was soft and slightly distended with the liver palpable 0.5 cm below the right costal margin and 2 cm below the xyphoid process. Arterial blood gas with patient breathing 100% oxygen revealed severe acidosis and carbon dioxide retention. The first chest film showed right pleural effusion. Chest tap was performed, and 90 cc serosanguineous fluid was aspirated. The white cells of the effusion were 1,971 with lymphocyte predominant. No microorganism or malignant cell was found. Severe respiratory distress and cyanosis persisted inspite of these managements. Follow up chest film at the age of 11 hours revealed the right chest was occupied by intestinal loops. A thoracotomy was performed with the impression of right diaphragmatic hernia. The operation findings included a very redundant membranous portion of diaphragm formed a large sac containing the liver and some bowel loops, the lower lobe of the right lung collapsed and was located high in the posterior chest cavity. Diaphragmatic plication and excision were done with transient improvement of the skin color. The baby's condition deteriorated and expired at the age of 25 hours despite of postoperative vasodilator and ventilator therapies.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Congenital right diaphragmatic eventration manifested with pleural effusion. Report of one case]. 263 24

Hypoplasia of the lungs is the cause of the high mortality of newborns with diaphragmatic hernia. Survival depends mainly on the development of the contralateral lung. Eighty percent of diaphragmatic hernias are postolateral hernias of the left side. The most serious postoperative complication is a relapse into fetal circulation with increased pulmonary vascular resistance and right-to-left shunting (Fig. 2). The clinical signs of diaphragmatic hernia are cyanosis and tachypnea. Intermittent suction via a nasogastric tube and early intubation without mask ventilation should be performed. The inspiratory pressure should not exceed 25 cm H2O to minimize the risk of pneumothorax. Survival of the baby is unlikely if the initial blood gas analysis shows pH less than 7.10, pO2 less than 50 mmHg, and pCO2 greater than 65 mmHg. Hypothermia should be strictly avoided because it leads to increased oxygen consumption. Intraoperative monitoring should include a precordial stethoscope, ECG, blood pressure, and rectal temperature. Anesthesia is maintained with fentanyl 0.02-0.03 mg/kg body wt. and pancuronium 0.08-0.1 mg/kg. One dose of atropine (0.02 mg/kg) is administered before fentanyl. Intraoperative ventilation is performed by hand or by use of a Siemens Servo ventilator. Thirty newborns were anesthetized for repair of a congenital diaphragmatic hernia with no intraoperative complication and an overall mortality of 27%.
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PMID:[Anesthesia for congenital diaphragmatic hernia]. 363 96

A congenital diaphragmatic hernia is the prenatal herniation of abdominal contents into the chest cavity; the infant usually has a hypoplastic lung on the side of the hernia. The neonate presents with cyanosis, tachypnea, retractions, and a scaphoid abdomen. A simple chest X-ray will confirm the diagnosis by revealing hollow viscera in the chest cavity. Survival is dependent upon rapid transport to a major surgical center equipped to perform the necessary surgery and provide the post-operative care. The newborn should be kept warm, well oxygenated, and normocapneic to avoid acidosis. Acidosis could result in reversal to fetal circulation, rapid deterioration, and death. Should we be called upon to transport a neonate with a congenital diaphragmatic hernia we must realize the severity of this anomaly and be prepared to prevent, recognize, and/or treat any life-threatening emergencies that occur.
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PMID:Air transport of the neonate with a congenital diaphragmatic hernia. 395 8

Morgagni hernias during infancy are associated with significant respiratory symptoms as well as other congenital anomalies, particularly congenital heart disease. During the past 6 years we have had the opportunity to treat five infants less than 1 year of age with Morgagni hernias. A review of the literature revealed an additional seventeen detailed case reports of infants with Morgagni hernias. Each of our patients was symptomatic as were all but two of those previously reported. These patients presented with tachypnea, dyspnea, and cyanosis which was very similar to the presentation of Bochdalek hernias seen during infancy. Thirteen of 16 patients in whom detailed descriptions of associated anomalies were given including four of our own patients, had significant congenital anomalies. Nine involved the heart, including three infants with dextracardia, three with ventricular septal defects, and two with anomalous pulmonary venous return. Five infants were retarded, including three with Trisomy 21. Two of the previously reported patients had large omphaloceles and other stigmata of Cantrell's syndrome. All but one of the patients reported, including ours, had a hernia sac. The liver, colon, and small bowel were most commonly found in the hernia sac; however, the presence of the stomach and spleen have been reported. While both the transabdominal and transthoracic approaches to Morgagni hernias have been advocated and, indeed, repair of the defect can be accomplished through both approaches, the transthoracic approach allows better exposure of incarcerated viscera, particularly the frequently found anomalous left lobe of the liver.
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PMID:Morgagni hernias during infancy: presentation and associated anomalies. 648 84


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