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

Despite surgical treatment, congenital foramen of Bochdalek diaphragmatic hernia continues to carry a high mortality rate due to associated respiratory insufficiency. We studied the pathologic and hemodynamic changes that result from this condition in lambs. Surgical creation of diaphragmatic hernias in fetal lambs was performed in utero with subsequent delivery by cesarean section near term. Cardiac catheterization was performed on these newborn lambs immediately after delivery, before and after surgical repair of the defect. Data from five of these lambs were compared to data obtained from seven normal lambs. Pulmonary hypertension was found only in lambs with hernias. Pulmonary artery pressures and the mean ratio of pulmonary to systemic resistance were higher in experimental lambs. Oxygen saturation and average cardiac index were higher in normals. Lambs in the experimental group, but not in the control group, had large left-to-right shunts at the level of the ductus arteriosus in the early neonatal period. Arterial oxygen saturations were consistently low with no differences in pre- and post-ductal samples, which suggests right-to-left shunting at the atrial level or physiologic shunting across the unexpanded lungs. No further expansion of the hypoplastic lungs occurred following decompression by surgical hernia repair, but transient hemodynamic improvement was noted in some cases. Surgical ligation of the ductus arteriosus did not significantly alter the clinical condition of the lambs. Lungs in lambs with hernias were grossly abnormal, the left appearing more hypoplastic than the right.
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PMID:Hemodynamics of congenital diaphragmatic hernia in lambs. 35 42

Ten cases of posterolateral diaphragmatic hernia have been operated upon the last two years. Three cases of these have successfully been operated in conventional way. In seven cases ductus arteriosus was closed. Only two cases survived. A preoperative evaluation is to be done. Depending on the blood-gas-analysis, the cases can be divided into cases belonging to the survival zone and cases belonging to the fatal zone according to Boix-Ochoa. If it is possible to increase the oxygen uptake and to expire the carbonic acid, the results seem to be good after conventional operation. If it not will be possible to increase the oxygen saturation and not even possible to reduce the CO2 pressure with a ventilator with 100 per cent oxygen, the cases are to be considered inoperable. In fatal zone cases, where a reduction of PCO2 is possible, but there are no possibilities to get an increased oxygen saturation, an operative closing of ductus can be tried if heart anoxia is treated with the aid of an oxygenator.
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PMID:[Experiences about ductus arteriosus closure with congenital diaphragmatic hernia (author's transl)]. 53 Jul 19

Two newborn infants with congenital diaphragmatic hernia, one of whom died, had significant improvement in arterial oxygen tension (Pao2) after intravenous administration of tolazoline (Priscoline) (1 to 2 mg. per kilogram). In both infants, systemic hypotension developed within minutes of administration of the drug and required pharmacologic and hemodynamic intervention. The response to tolazoline was more dramatic in the infant who survived, and his oxygen requirements were significantly reduced after the use of this drug. The infant who died also had a significant response to tolazoline. Tolazoline appears to be an important pharmacologic agent for use in the postoperative care of infants with diaphragmatic hernia and associated hypoxemia and acidosis.
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PMID:Use of tolazoline in newborn infants with diaphragmatic hernia and severe cardiopulmonary disease. A preliminary report. 64 68

In 20 newborns with congenital diaphragmatic hernia the state of the pulmonary function was studied through the blood gas values (PO2 and PCO2 on breathing air and 100% oxygen spontaneously or with mechanical ventilation). The group of survivors presented a normal or slightly altered pulmonary function, whilst in the group that died the pulmonary function was severely altered. Up to now, and in accordance with the results obtained, none of the proposed hypothesis (pulmonary atelectasis, extra-pulmonary right-to-left shunt, pulmonary hypoplasia) explain this alteration in a satisfactory manner. From the prognostic point of view, if the levels of gases are spontaneously normal or with administration of oxygen and/or assisted, ventilation a level of PO2 higher than 230 and of PCO2 lower than 70 is obtained, prognosis is excellent. If these levels are not obtained the prognosis is nearly always fatal and the value of the intervention questionable.
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PMID:[Pulmonary gas exchange in newborns with congenital diaphragmatic hernia (author's transl)]. 74 66

To determine the effects of the pulmonary hypoplasia present at birth in infants with congenital diaphragmatic hernia upon subsequent development of the lung, 19 patients who had undergone surgical repair before the age of one year were studied at ages 6 to 18 years. Total lung capacity and vital capacity averaged 99% of predicted value. Diffusing capacity for carbon monoxide was normal. Forced expiratory volume in one second averaged 89% of predicted value and 80% of vital capacity. Total respiratory system conductance and maximum expiratory flow volume curves obtained during air and helium-oxygen breathing were normal. Xenon 133 radiospirometry performed in nine patients revealed equal distribution of lung volumes on the two sides. Ventilation to the hernia side was reduced in only two patients. Blood flow to the hernia side was reduced in all nine patients. Chest radiographs supported the physiologic observations. These findings are consistent with the persistence of a reduction in the number of branches or generations of pulmonary arteries and bronchi on the side of the hernia. Since a substantial part of the vascular resistance resides in peripheral vessels, this developmental abnormality influences the distribution of pulmonary blood flow, although it has little effect on tests reflecting airway resistance or the distribution of ventilation.
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PMID:The lung following repair of congenital diaphragmatic hernia. 83 33

As a part of a preoperative investigation, spirometry and blood gas tensions were studied in 64 subjects with X-ray-verified hiatus hernia (34 sliding, 22 mixed, and 8 of paraesophageal variety). According to the transverse diameter of the hernia. They were divided into 3 groups, small (2-5.9 cm), medium (6-9.9 cm), and large (10-17 cm) hernias. No correlation between the size of the hernia, reflux incidence, and spirometric findings could be demonstrated. A significant reduction of the arterial oxygen tension was found in small hernias and in vital capacity and maximal voluntary ventilation (MVV) in medium-sized hernias. Significant reduction in MVV was noted in the large hernia group. A common spirometric finding in all groups was a significant increase in residual volume and wash-out volume. The incidence of restrictive or obstructive pulmonary impairment was high in large (39%) and small (32%) hernias and relatively low in medium-sized hernias (8%). Roentgenological fibrosis was not found in any of the patients, while 4 showed emphysematous changes.
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PMID:Respiratory function in esophageal hiatus hernia. I. Spirometry, gas distribution, and arterial blood gases. 111 79

Seventy-two patients with congenital diaphragmatic hernia (CDH) diagnosed in the first 12 hours of live have been reviewed retrospectively. Forty-eight patients born before 1985 (group I) were compared to 24 patients born between 1985 and 1989 (group II). The management was different for the 2 groups. Group I was operated on immediately. For group II, delayed surgery after stabilization was preferred. For this group, stability was sought before, during and after surgery. Therapy was first aimed at optimizing ventilation and oxygenation by way mechanical ventilation. Pharmacologic agents were used in an attempt to decrease pulmonary vascular resistance and improve cardiac output. The survival rate was 37.5% before 1985, 62.5% after 1985 (P less than 0.01). Main prognostic factors were Apgar score, paCO2, pH, ventilation index, alveolar-arterial difference in oxygen and oxygenation index. The stabilization before surgery improved the survival rate.
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PMID:[Congenital diaphragmatic hernia. Value of preoperative stabilization]. 131 28

One hundred ten infants with congenital diaphragmatic hernia (CDH) developed life-threatening respiratory distress in the first 6 hours of life. Associated anomalies were present in 33%. Twenty-eight of 65 infants (43%) treated before 1987 (pre-extracorporeal membrane oxygenation [ECMO] era) survived after immediate CDH repair, and mechanical ventilation with or without pharmacologic support. Only two of 16 (12.5%) infants requiring a prosthetic diaphragmatic patch survived. Since 1987, 31 of 46 (67.4%) infants with birth weight, gestational age, and severity of illness similar to the pre-1987 group survived. All patients were immediately intubated and ventilated. Seven (four with lethal chromosomal anomalies) infants died before treatment, and 30 stabilized (partial pressure of carbon dioxide [PCO2] < 50; partial pressure of oxygen [PO2] > 100; pH > 7.3) and underwent delayed CDH repair at 5 to 72 hours. Fifteen did well on conventional support and survived. Fifteen infants deteriorated after operation: 11 were placed on ECMO with eight survivors, and four infants were not considered ECMO candidates. Nine babies failed to stabilize initially and were placed on ECMO before CDH repair (alveolar-arterial gradient > 600 and oxygenation index > 40), and seven survived. The overall survival rate was 80% at 3 months in this ECMO-treated group. Early mortality was due to inability to wean from ECMO (one), intracranial hemorrhage (one), liver injury (one), and pulmonary hypoplasia (one). Nine of 11 babies requiring a prosthetic patch in the post-1987 ECMO group survived (81.8%). There were three late post-ECMO deaths (3 to 18 months) of right heart failure (two) and sepsis (one). Symptomatic gastroesophageal reflux occurred in nine cases, six requiring a fundoplication in the bypass babies. Recurrent diaphragmatic hernia occurred in nine cases (five ECMO). The overall survival rate was significantly improved in the delayed repair/ECMO group (67% versus 43%; p < 0.05) and was most noticeable in infants requiring a prosthetic diaphragm (81.2% versus 12.5%; p < 0.005). These data indicate that early stabilization, delayed repair, and ECMO improve survival in high-risk CDH. Early deaths are related to pulmonary hypertension and can be reversed by ECMO.
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PMID:Delayed surgical repair and ECMO improves survival in congenital diaphragmatic hernia. 141 95

We developed an experimental rat model of congenital diaphragmatic hernia (CDH) to elucidate the etiology and pathogenesis of this serious congenital anomaly in humans and in particular to study the effects of a short period of artificial ventilation on the CDH lung in relation to antioxidant defense mechanisms. CDH was induced in about 60% of the offspring by maternal exposure to 2,4-dichlorophenyl-p-nitrophenylether (Nitrofen) during pregnancy. This herbicide resembles thyroid hormone in chemical structure. The lungs of fetal rats (d 19, 20, 21, and 22) were examined for protein and DNA content and activity of superoxide dismutase, catalase, and glutathione peroxidase (GPX). The same parameters were assessed in tracheotomized newborn rats after pressure-controlled artificial ventilation with either room air or pure oxygen during a short period of 5 h. In both CDH rats and controls, wet lung weight increased during gestation. At term, CDH rats had significantly lower mean lung weights than controls. Neither group differed in protein and DNA content per mg lung or superoxide dismutase, catalase, and GPX activity before and at birth. After artificial ventilation of neonates with air and pure oxygen, superoxide dismutase activity tended to decrease, whereas catalase activity remained virtually unchanged in the CDH lung. However, GPX activity in the CDH lung was reduced to 80% of initial activity at term after ventilation with air and to 70% with pure oxygen. The present finding of a decline in GPX activity in this animal model after a short period of artificial ventilation may indicate that the CDH rat neonate is at risk to develop oxygen-related lung damage.
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PMID:Nitrofen-induced diaphragmatic hernias in rats: pulmonary antioxidant enzyme activities. 143 89

Availability of extracorporeal membrane oxygenation (ECMO) support and the potential advantages of delayed repair of congenital diaphragmatic hernia (CDH) have led several centers to delay CDH repair, using ECMO support if necessary. This study reviews the combined experience of five ECMO centers with infants who underwent stabilization with ECMO and repair of CDH while still on ECMO. All infants were symptomatic at birth, with a mean arterial oxygen pressure (PaO2) of 34 mmHg on institution of bypass despite maximal ventilatory support. A total of 42 infants were repaired on ECMO, with 18 (43%) surviving. Seven infants had total absence of the diaphragm, and 28 required a prosthetic patch to close the defect. Only five infants ever achieved a best postductal PaO2 over 100 mmHg before institution of ECMO. Prematurity was a significant risk factor, with no infants younger than 37 weeks of age surviving. Significant hemorrhage on bypass was also a hallmark of a poor outcome, with 10 of the 24 nonsurvivors requiring five thoracotomies and six laparotomies to control bleeding, whereas only one survivor required a thoracotomy to control bleeding. In follow-up, nine of the 18 survivors (50%) have developed recurrent herniation and seven (43%) have significant gastroesophageal reflux. Importantly, five of the 18 survivors were in the extremely high-risk group who never achieved a PaO2 over 100 mmHg or an arterial carbon dioxide pressure (PaCO2) less than 40 mmHg before the institution of ECMO. In conclusion, preoperative stabilization with ECMO and repair on bypass may allow some high-risk infants to survive. Surviving infants will require long-term follow-up because many will require secondary operations.
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PMID:Congenital diaphragmatic hernia. Stabilization and repair on ECMO. 144 48


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