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

Combined high-frequency oscillatory ventilation (HFOV) and intermittent mandatory ventilation (IMV) was used in 12 neonates with inadequate gas exchange with conventional IMV. Diagnoses included diaphragmatic hernia with hypoplastic lungs, pneumonia, persistent fetal circulation, and severe respiratory distress syndrome. In most patients there was severe air leak. Within 10 hours of beginning HFOV-IMV the mean arterial PCO2 fell from 60 +/- 5 (means +/- SEM) to 38 +/- 2 mm Hg (P less than 0.01) and the mean IMV rate was reduced from 96 +/- 8 to 17 +/- 4 breaths per minute (P less than 0.001). The mean arterial-alveolar oxygen tension ratio rose from 0.05 +/- 0.01 to 0.09 +/- 0.01 (P less than 0.005). Mean airway pressure in the trachea was reduced from 16 +/- 2 to 10 +/- 3 cm H2O (P less than 0.05). Four patients died, three of whom had diaphragmatic hernias with hypoplastic lungs. Five of the eight survivors had mild bronchopulmonary dysplasia requiring supplemental oxygen. These studies demonstrate that in some neonates with respiratory failure who fail to respond to conventional IMV, combined HFOV-IMV can be successful.
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PMID:Combined high-frequency oscillatory ventilation and intermittent mandatory ventilation in critically ill neonates. 637 37

We have seen a modest improvement in the survival of a homogeneous group of critically ill newborns with congenital diaphragmatic hernia since 1979. Twenty-seven "critical" infants have been treated who developed respiratory distress shortly after birth, required urgent resuscitation, and could not be stabilized before operation. Two died with other anomalies that appeared incompatible with prolonged survival. Ten of the 27 lived. This survival contrasts with that of only two of 17 similarly affected babies treated from 1962 to 1978. In addition, there has been no operative mortality outside of this "critical" group since 1979; whereas six noncritical babies died between 1967 to 1978. Our current therapeutic plan includes the early establishment of a respiratory alkalosis and vasodilator therapy before or during transport. Postoperatively we have attempted to maintain the baby's arterial pH greater than 7.5, Pco2 less than 25 to 30 and the PO2 approximately 150 torr. The most effective ventilatory parameters have been a rate of 130, PEEP of 5 and an inspiratory:expiratory ratio of 1:1. Peak airway pressures are kept as low as possible. Pharmacologic and ventilator therapy are weaned slowly, and intensive support has been required for at least 48 hours in each baby. Retained secretions and atelectasis of the hypoplastic lung persisted for two to several weeks postoperatively. Two babies that are one year or older still appear to have severely hypoplastic lungs on chest x-ray. M-mode echocardiography has been used to measure ventricular ejection periods. The right ventricular systolic time interval correlates with the degree of pulmonary hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The "critical" neonate with diaphragmatic hernia: a 21-year perspective. 648 79

A case of a newborn with bilateral Bochdalek's diaphragmatic hernia is reported. Because of respiratory distress the patient had to be operated on urgently; the left diaphragmatic hernia was repaired. On the 12th day of life, relaparatomy was performed and the right diaphragma was operated because of a suspected ileus. The clinical course was good and at the age of 11 weeks the patient was discharged. This malformation is extremely rare. Extensively studied cases of bilateral diaphragmatic hernia are not often found in literature.
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PMID:[Bilateral diaphragmatic hernia]. 651 96

Four cases of pleuroperitoneals diaphragmatic hernia are described. The onset in the four infants was intensive respiratory distress. In all patients the only herniated viscera was the stomach, that was found strangulated and dilated into the thoracic cavity. The foramen herniarium was located on the diaphragmatic cupula with a size between 2-3 cm.
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PMID:[Late presentation of pleuroperitoneal diaphragmatic hernias with intrathoracic gastric strangulation]. 661 72

During a retrospective multicentric study of the encountered congenital pathology of the diaphragmatic domes, we focused our special attention on the prevalence of the congenital Bochdalek hernia. 140 charts were statistically analysed. The seriousness of the medical and surgical emergency situation enticed the authors to examine the most important prognostic clinical features. The interval between diagnosis and surgical therapy should be as short as possible. Respiratory acidosis and resuscitation were a common denomination in all infants who succumbed in the post-operative period. The early occurrence (less than 6 hrs) of respiratory distress disclosed the seriousness of the associated pulmonary hypoplasia. Surgical technical problems were rare. This in contrast to the struggle against pulmonary arterial and capillary hypertension. Pulmonary vasodilator drugs have not convinced those who initiated their use.
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PMID:[Bochdalek's congenital diaphragmatic hernia: a clinical review of 114 cases]. 671 Dec 39

This is a case report of a peritoneo-pericardial diaphragmatic hernia revealed by a respiratory distress in a newborn infant. Radiography and angiocardiography allowed preoperative diagnostic and the patient was operated upon successfully on two days of age. Anatomic finding was a defect of the central tendon of the diaphragm with a hernial sac. This anomaly is rare and probably results from a misdevelopment of the septum transversum.
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PMID:[Abdomino-pericardial hernia as a result of an anomaly of the septum transversum. Apropos of a case in a newborn infant]. 685 Sep 65

From March 1978 to April 1982 13 neonates with a left posterolateral diaphragmatic hernia were seen in respiratory distress within 12 hours of birth. Each had severe acidosis and hypoxia. They were immediately intubated and ventilated. Arterial and central venous lines were inserted, the acidosis was partially corrected, and a dopamine infusion of 4-8 micrograms/kg/min was begun immediately. Continuous monitoring of arterial and venous pressures, core and skin temperatures, blood gases, and pH was instituted. Diaphragmatic defects were repaired by direct suture in nine neonates and by Gore-Tex patches in four. The left lung in all patients was hypoplastic. Ventilation and inotropic support were continued for four to five days after operation and close control of acid-base balance was maintained. All but one survive and are doing well. We consider the key to survival to be management of the dangerous combination of acidosis (by enhancing peripheral and renal perfusion with dopamine) and hypoxia (by prolonged assisted ventilation).
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PMID:Management of neonatal posterolateral diaphragmatic hernia. 686 75

There were 47 seriously-ill neonates with medical causes of respiratory distress and 10 infants with severe respiratory distress secondary to a congenital diaphragmatic hernia treated with tolazoline according to a strict protocol designed to manage persistent fetal circulation (PFC). Of the 47 infants, 28 (60%) had a positive response defined as an increase in the pO2 greater than or equal to 24 mm Hg within 4 hr of beginning the drug. Of 7 infants, 4 with congenital diaphragmatic hernia had a positive response. The mean increase in the pO2 for the 47 infants was statistically significant (p less than .05). Of the 47 infants with medical disorders, 27 survived (survival 57%), whereas only 2 of the 10 infants with congenital diaphragmatic hernia and severe persistent fetal circulation survived (survival 28%). Erythema (60%), hematest positive gastric aspirates (55%), thrombocytopenia (45%), hyponatremia (40%) and increased gastric aspirates (36%) were the most common adverse effects occurring during tolazoline infusion. Hypotension occurred in nine cases, but was transient. Of the 27 survivors, 20 with medical causes of persistent fetal circulation were evaluated at age 1 yr. Eighty percent of these infants studied were considered normal as defined by an MDI and PI of the Bayley Scales of greater than or equal to 70. These data suggest that tolazoline is a useful adjunct in the management of neonates with PFC. In addition, tolazoline was more effective in mechanically ventilated neonates treated with respiratory paralytic agents. Although tolazoline resulted in a significant improvement in the paO2 in 4 infants with congenital diaphragmatic hernia, it did not appear to improve mortality in these infants.
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PMID:An analysis of tolazoline therapy in the critically-ill neonate. 697 Feb 61

A newborn baby who presented with neonatal pneumonia due to group B streptococcus and who required artificial ventilation is described. After the infant was weaned from the respirator, increasing respiratory distress led to the diagnosis of posterolateral diaphragmatic hernia.
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PMID:"Acquired" congenital diaphragmatic hernia following early onset group B streptococcal pneumonia. 699 91

Between March, 1978, and August, 1980, 7 neonates with a left posterolateral diaphragmatic hernia were seen in respiratory distress within 12 hours of birth. Each had severe acidosis and hypoxia. They were immediately intubated and ventilated. Arterial and central venous lines were inserted, the acidosis was partially corrected, and a dopamine infusion of 5 microgram/kg/min was begun immediately. Continuous monitoring of arterial and venous pressures, core, and skin temperatures, blood gases, and pH was instituted. Diaphragmatic defects were repaired by direct suture in 5 neonates and by Gore-Tex patches in the other 2. The left lung in all patients was hypoplastic. Ventilation and inotropic support were continued for 4 to 5 days post-operatively, and close control of acid-base balance was maintained. All the patients are doing well. We consider the key to survival to be management of the dangerous combination of acidosis (by enhancing peripheral and renal perfusion with dopamine) and hypoxia (by prolonged assisted ventilation).
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PMID:The management of neonatal posterolateral diaphragmatic hernia. 703 34


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