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

Extracorporeal Life Support Organization (ELSO) registry data show increased mortality in congenital diaphragmatic hernia (CDH) infants compared with other extracorporeal membrane oxygenation (ECMO) indications. To test the hypothesis that death might be related to various clinical parameters, retrospective data collection was solicited on 175 ECMO-related CDH deaths from 41 American ECMO centers (ELSO Registry 1980 through 1989). Data capture forms were received on 100 of 175 infants representing 29 of 41 centers. After review of all available material, a predominant cause of death was assigned. Other diagnoses were given secondary status. We analyzed arterial blood gas values at 6, 3, and 1 hour pre-ECMO, as well as at the time of highest recorded PO2 (preductal and postductal) and lowest recorded PCO2, and correlated these findings with predominant cause of death. The relationship between individual variables and cause of death was assessed by t test. Multivariate analysis was performed by using a stepwise discriminate procedure. The most common predominant causes of death were brain death (29%), pulmonary hypertension (25%), and pulmonary hypoplasia (17%). Correlation of arterial blood gas values at 6, 3, and 1 hour pre-ECMO with predominant causes of death established the following statistically significant associations (P less than .05): (1) pulmonary hypoplasia and low PO2 at 6 hours pre-ECMO; (2) brain death and low pH at 1 hour pre-ECMO; and (3) pulmonary hypertension and high HCO3- at 1 hour pre-ECMO.(ABSTRACT TRUNCATED AT 250 WORDS)
J Pediatr Surg 1991 Sep
PMID:Congenital diaphragmatic hernia, extracorporeal membrane oxygenation, and death: a spectrum of etiologies. 194 77

Infants with congenital diaphragmatic hernia (CDH) demonstrate a wide range of anatomic and physiologic abnormalities, making it difficult to compare the efficacy of new forms of therapy such as extracorporeal membrane oxygenation (ECMO) among institutions. This study was undertaken to determine whether any predictors of severity could be identified in the ECMO era. The charts of all patients with CDH treated at this institution since 1984, when ECMO became available. (n = 110), were reviewed. Infants were considered high risk and included in this study if they presented with respiratory distress within the first 6 hours of life (n = 94). In order to focus on predictors of pulmonary insufficiency, patients who died of nonpulmonary causes or had other significant congenital anomalies were excluded from this review, leaving 59 patients for analysis. All the infants during this period had intensive pharmacological and ventilatory support. When needed, ECMO was offered postoperatively from 1984 to 1987, and preoperatively from 1987 to the present. Forty-five of 59 had a best postductal PO2 (BPDPO2) greater than 100 mm Hg, and 41 of these responders survived (91%). Fourteen patients had a BPDPO2 less than 100 mm Hg and only one survived (7%) (P = .0001). Mean BPDPO2 between survivors with or without ECMO, and nonsurvivors were also significantly different (P = .001). To incorporate ventilatory information, an oxygenation/ventilation index was devised: [OVI = PO2/(mean airway pressure x respiratory rate) x 100]. Differences in OVI between these three groups were also significant. When analyzing the data by the method proposed by Bohn (PCO2 v VI), no correlation between ventilatory parameters and outcome was found.(ABSTRACT TRUNCATED AT 250 WORDS)
J Pediatr Surg 1991 Sep
PMID:Congenital diaphragmatic hernia: predictors of severity in the ECMO era. 194 78

The management of a child with an irreducible ovary remains inconsistent in pediatric surgical centers. An informal survey of senior pediatric surgeons and an extensive review of the literature showed a prevailing view that the trapped ovary is not at significant risk of vascular compromise. Two recent cases prompted a review of our experience from 1984 to 1989, during which 1,699 children with inguinal hernias underwent operation, 386 (23%) of whom were girls. Fifteen girls (4%) had irreducible ovaries present at the time of operation and in 4 of the 15 (27%) the ovary was twisted and infarcted. Two of the 4 girls were known to have an irreducible ovary prior to the day of operation--1 was noted 2 months earlier and 1 was noted 1 month earlier. At the time of the initial diagnosis, neither patient had physical findings of vascular compromise of the ovary. In the other two girls, evidence of an infarcted ovary was present when the hernia was first diagnosed and an emergency operation was performed. A 27% incidence of torsion and strangulation of irreducible ovaries appears to be high, but reports of strangulated ovaries have been reported in 2% to 33% of other series. The normal anatomy is altered when an ovary is trapped in a hernia sac, and these changes make torsion more likely. Although an irreducible ovary is not at great risk of compression of its blood supply, this report identifies a significant risk of torsion. This risk warrants treating the asymptomatic irreducible ovary as any other incarcerated hernia--as a true emergency.
J Pediatr Surg 1991 Sep
PMID:The irreducible ovary: a true emergency. 194 79

The incidence of reflux-esophagitis was studied in 574 dispensary patients and 217 patients operated upon for ulcer disease. It was found that reflux-esophagitis is observed in 19.8% of patients with ulcer disease and in 34% of such patients subject to operation. The main cause of it is incompetence of the cardiac sphincter without or in combination with a hernia of the esophageal opening. It was noted that vagotomy leads to a disturbance of the ligamentous system of the cardio-esophageal zone and in all cases leads to the development of reflux-esophagitis. Fundoesophagorraphy is thought to be the best method of preoperative treatment of reflux-esophagitis.
Vestn Khir Im I I Grek 1990 Sep
PMID:[Prevention of postoperative reflux esophagitis in patients with duodenal ulcer]. 196 40

A prospective study of outcome after inguinal hernia repair in patients undergoing simultaneous repair of bilateral hernias (n = 31), sequential repair of bilateral hernias (n = 5), and unilateral hernia repair (n = 75) is reported. There were no differences in wound complications, post-operative respiratory complications, or other adverse effects in the three groups. Operating time was similar in the unilateral and bilateral simultaneous repairs (median 55 min), but was longer (100 min) for the combination of two sequential repairs. Hospital stay was shortest for patients undergoing unilateral repair (2 days) but was less with bilateral simultaneous repair (4 days) than after two sequential repairs (total of 6 days). There were 12 (11%) wound complications of which five (5%) were infections. There was no difference in complication rate between unilateral and bilateral hernia repair. Postoperative recovery was assessed prospectively and was recorded at 1 month. There was no difference between unilateral and bilateral simultaneous repairs in the number of days before the patient was able to climb stairs easily, drive a car or return to work. The duration of the requirement for analgesia was similar in each group. We conclude that bilateral simultaneous hernia repair can be carried out with no greater morbidity than a unilateral repair, and the return to normal activity is as rapid. Bilateral hernias should be repaired simultaneously rather than sequentially.
Ann R Coll Surg Engl 1990 Sep
PMID:A prospective study of bilateral inguinal hernia repair. 222 64

A prospective study of 10 neonates with congenital diaphragmatic hernia and five controls to determine the importance of prostanoid concentrations perioperatively and the relation with persistent pulmonary hypertension (PPH) is reported. In neonates with congenital diaphragmatic hernia postoperative concentrations of the vasoconstrictor thromboxane B2 rose significantly and were higher during episodes of PPH; this rise may provoke PPH and subsequent right to left shunting.
Arch Dis Child 1990 Sep
PMID:Congenital diaphragmatic hernia: impact of prostanoids in the perioperative period. 222 77

Femoral hernia is rare in children. Unfamiliarity with the occurrence of this condition may lead to incorrect diagnosis and delayed treatment. This mistake can be obviated by careful clinical examination.
Br J Clin Pract 1990 Sep
PMID:Femoral hernia in children. 222 37

Sonographic technology has given the prenatal diagnostician the ability to accurately visualize fetal malformations. This article demonstrates the currently available capability of applying sonographically derived information concerning fetal dysmorphology to our knowledge of genetic disorders and syndromes. As a result, there can be a significant improvement in the management and counseling of these patients. After an initial discussion of normal embryology, principles of abdominal ultrasonography are discussed and applied to the following anomalies: omphalocele, gastroschisis, diaphragmatic hernia, duodenal atresia, other intestinal atresias and stenoses, renal anomalies, and obstructive uropathies.
Clin Perinatol 1990 Sep
PMID:Fetal abdominal abnormalities associated with genetic syndromes. 222 92

This article presents endoscopic evaluation of the pleural cavity, or thoracoscopy, an effective diagnostic technique that can be employed to provide additional diagnostic information in cases of intrathoracic disease. The techniques of thoracoscopy are described, and normal and abnormal findings are discussed. Thoracoscopy allows visual examination of the pleural space and surrounding structures without surgical exploration. The stress, expense, morbidity, and mortality of thoracoscopy are far less than those of thoracotomy. Disease for which thoracoscopy has been employed diagnostically include primary and metastatic neoplasia, hilar lymphadenopathy, pericardial effusion, spontaneous pneumothorax, and diaphragmatic hernia. Therapeutically, thoracoscopy has been used for drainage of pericardial effusion.
Vet Clin North Am Small Anim Pract 1990 Sep
PMID:Thoracoscopy. 223 74

We report a rare case of Bochdalekhs hernia, congenital posterolateral diaphragmatic hernia with mesenterioaxia volvulus of the stomach, in an adult. A 23-year-old man suddenly felt severe pain in his left chest after drinking beer. Roentgenologic examination of the chest showed air above the left diaphragm, and the mediastinum was displaced to the right. Upper gastrointestinal series revealed mesenterioaxial volvulus of the stomach in which the pylorus was displaced to the left. Thoracotomy through the left seventh intercostal space was performed. The stomach, colon, spleen and greater omentum were displaced into the left thoracic cavity. After reduction of the herniated viscera, a defect measuring 10 X 4 cm, in the posterolateral part of the diaphragm, was closed with double interrupted Tevdek sutures. Three months later, he was asymptomatic and his chest roentgenogram was normal.
Nihon Kyobu Geka Gakkai Zasshi 1990 Sep
PMID:[A case report of Bochdalek's hernia with volvulus of the stomach in an adult]. 224 36


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