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

Thirty-two infants were treated for congenital diaphragmatic hernia at our institution from 1979 to 1984. Eight were in no or minimal distress at birth and had operative intervention when they were more than 24 hours old; survival was 100%. The remaining 24 neonates required immediate intubation and ventilation followed by operation at less than 12 hours of age. Overall survival was 54%; survival was 31% (4 of 13 patients, Group 1) in the first three years of the series and 82% (9 of 11 patients, Group 2) in the last three years (p less than 0.001). Apgar score, gestational age, birth weight, and incidence of associated congenital heart disease were equal for the two groups (all, p greater than 0.05). The two groups also were examined with reference to alveolar-arterial oxygen differences P(A-a)O2 and mean airway pressure (MAP). The best preoperative P(A-a)O2 was greater than 600 mm Hg for 7 neonates in Group 1 and 6 in Group 2, and survival was 0% and 71%, respectively (p less than 0.001). Infants with a postoperative MAP of 13 cm H2O or greater had a higher mortality (100% in Group 1 and 50% in Group 2, p greater than 0.05). Our treatment protocol was studied to determine those methods related to improved survival. Sodium bicarbonate infusion was used earlier in Group 2 as a prophylaxis against persistent fetal circulation (PFC) (p greater than 0.05). The incidence of severe PFC dropped from 85 to 54% (p greater than 0.05). Higher ventilator rates rather than pressures were used to achieve equally effective ventilation.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Improving survival in the treatment of congenital diaphragmatic hernia. 394 36

To prevent the severe prognosis of pulmonary hypoplasia in congenital diaphragmatic hernia, the authors developed a new method of ventilation, using a modulated mixture of helium and oxygen. Associated with a leptanalgesia (Chlorpromazine-Morphine), the authors observed with this method two good results. Efficiency of this technique has been confirmed by X-rays and successive pulmonary scintigraphies (Xenon 133).
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PMID:A new method of ventilation with a mixture of helium and oxygen in the management of congenital diaphragmatic hernia. A preliminary study. 406 Oct 13

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

Three critically ill infants who had persistent fetal circulation postoperatively, refractile to tolazoline and 100% oxygen with mechanical ventilation including continuous positive airway pressure, responded favourably to prolonged manual hyperventilation. Two infants had undergone repair of a diaphragmatic hernia and the third had correction of a tracheoesophageal fistula. Normal respiratory function was documented in two survivors. The third died 14 days postoperatively. The use of this simple technique indicated that perseverance can be rewarded in the treatment of persistent fetal circulation unresponsive to the usual medical management.
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PMID:Persistent fetal circulation in neonates postoperatively: the value of manual ventilation. 640 28

Two groups of six patients were studied during light general anaesthesia using 2% enflurane and 66% nitrous oxide in oxygen, combined with regional anaesthesia, for hernia and varicose vein surgery. The effects of 3% enflurane were compared with those of fentanyl 0.3 microgram kg-1 i.v., by measuring inspired flow, tidal volume, the timing of inspiration and expiration, and occlusion pressure. Three per cent enflurane decreased ventilation by 12%. Tidal volume, mean inspiratory flow and occlusion pressure were decreased in approximately equal proportions (14, 12 and 8%, respectively). The timing of breathing did not change significantly. Fentanyl did not influence tidal volume. Ventilation was decreased by 28% as a result of a 10% decrease in inspiratory flow and a marked increase in the duration of expiration by 45%. The pattern of activation of the inspiratory muscles, as indicated by occlusion pressure, was changed by fentanyl. During enflurane and nitrous oxide anaesthesia, depression of ventilation by fentanyl or increases in enflurane concentration was not by a common central depressant mechanism.
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PMID:Comparison of decreases in ventilation caused by enflurane and fentanyl during anaesthesia. 661 70

The chances of survival of infants with congenital diaphragmatic hernia have improved only slightly in recent years. Hence, surgery has little to offer towards improvement of prognosis. For this reason, new avenues must be explored which guarantee the functioning of post-foetal circulation and prevent a relapse into the foetal circulation. The emphasis is on continuous registration of the preductal and post-ductal arterial oxygen content, of the pressure conditions in the pulmonary artery and the extent of a right-left shunt. Among the most important therapeutic measures are high-frequency ventilation, effective control of acidosis and the use of vasodilators with pulmonary effectivity. However, their management requires special experience to avoid or control the frequent side effects.
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PMID:[Congenital diaphragmatic hernias]. 663 95

Some newborn infants with either primary or secondary persistent pulmonary hypertension (PPHN) remain hypoxemic, hypercarbic, and acidotic despite therapeutic efforts. In autopsies of 23 infants who had PPHN, diffuse platelet-fibrin thrombi were present in the pulmonary microcirculation of eight (15.2 +/- 18.1 thrombi/cm2 lung tissue) and absent in 15 (0.2 +/- 0.3 thrombi/cm2 lung tissue), (P less than 0.004). Diagnoses in group A (thrombi) were pneumonia and sepsis (four patients), meconium inhalation (3), and primary PPHN (1); and in group B (no thrombi) pneumonia and sepsis (4), meconium inhalation (4), primary PPHN (4), hyaline membrane disease (2), and diaphragmatic hernia (1). The only significant differences between the two groups were the response to tolazoline infusion as assessed by changes in partial pressure of arterial oxygen (PaO2) and the platelet counts. Group A responded less favorably to tolazoline (14.8 mm Hg vs 83.6 mm Hg; P less than 0.05) and had lower platelet counts (51,000/microliter vs 128,000/microliter) (P less than 0.01) than group B. No significant differences could be detected in Apgar scores, duration or mode of mechanical ventilation, oxygen requirements, arterial blood gas tensions or pH, systemic arterial blood pressure, coagulation profile, amount of blood product transfusions, or intravascular catheter use. Pulmonary microthrombi should be added to the list of mechanisms for PPHN and may explain why some infants do not respond well to therapeutic efforts aimed at vasodilation. Thrombocytopenia and failure to respond to pulmonary vasodilators might suggest the diagnosis.
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PMID:Pulmonary microthrombi syndrome in newborn infants with unresponsive persistent pulmonary hypertension. 682 42

Almost all types of newborn respiratory failure are reversible. However, supportive treatment (oxygen and positive airway pressure) can damage the lung, and newborn respiratory failure remains a major cause of morbidity and death in infants. Prolonged extracorporeal membrane oxygenation (ECMO) provides life support while allowing the lung to "rest." We have used ECMO in 45 moribund newborn infants; 25 survived. Neonatologists referred patients who were unresponsive to maximal therapy. The right atrium and aortic arch were cannulated via the jugular vein and carotid artery. Heparin was infused continuously to main activated clotting time at 200 to 300 seconds. Airway oxygenation and pressure were reduced to low levels. Primary diagnoses were hyaline membrane disease, 14 (6 survived, 8 died); meconium aspiration, 22 (15 survived, 7 died); persistent fetal circulation including diaphragmatic hernia, 5 (3 survived, 2 died); and sepsis, 4 (1 survived, 3 died). Growth, development, and brain and lung function are normal in 20 of 25 survivors. ECMO decreased newborn respiratory failure mortality and morbidity rates in this phase I trial. A controlled randomized study is underway. The results suggest that ECMO may be effective in older patients if used before irreversible lung damage occurs.
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PMID:Extracorporeal membrane oxygenation for newborn respiratory failure: forty-five cases. 710 Nov 33

A retrospective analysis of 93 consecutive children with congenital posterolateral diaphragmatic hernia (CDH) was performed to determine outcome, ability to predict the development of persistent fetal circulation (PFC) requiring pharmacologic or extracorporeal membrane oxygenation (ECMO), and whether drugs or ECMO have improved survival. No patient died who was more than 24 hours of age at operation. Of 66 (71%) infants who were younger than 24 hours, 38 (58%) died. Preoperative and postoperative alveolar-arterial oxygen differences (AaDo2) did not consistently predict survival or death. Pharmacologic management of PFC in 30 patients resulted in a temporary improvement in 13 (43%). Survival was attributable to drugs in only seven (23%). ECMO was used in eight patients, all of whom had failed to improve with pharmacologic therapy and had a 100% predicted mortality rate based on the Neonatal Pulmonary Insufficiency Index. All eight had temporary improvement, while five (62%) completely cleared the PFC and four (50%) survived. Significant complications occurred in six patients. Earlier and more reliable methods of predicting high-risk infants are needed. Pharmacologic manipulation of PFC associated with CDH did not significantly improve survival. ECMO may prove to be a useful means of supporting these infants until more effective ventilatory and pharmacologic methods become available.
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PMID:Congenital posterolateral diaphragmatic hernia: new dimensions in management. 712 87

The effect of oxygen on chromosomes in bone marrow cells and on the early stages of gestation in the mouse were studied. Three groups of male mice were exposed to hyperbaric oxygen at 2, 3 and 4 atm abs. for 1 h, and four other groups breathed pure oxygen at 1 atm abs, for 6, 12, 24 and 48 h respectively. Chromosome were studied after 24 h. In the pure oxygen groups, no significant increase in chromosome aberration was noted, but in the hyperbaric oxygen groups, significant increases in abnormalities (breakage and gap) were noted at 3 and 4 atm abs. (8.0 and 6.7% respectively, P less than 0.05). In another study, four groups of pregnant mice were exposed once to hyperbaric oxygen at either 2 atm abs. for 1 h on the 7th or 8th day of gestation, or 2.5 atm abs. for 2 h on the 5th or 8th day. Six other groups were exposed to 2, 3 and 3.5 atm abs. with either oxygen or air for 1 h daily during first 8 days of gestation. Malformations (umbilical hernia and abnormalities of the coccyx) in the newborn were noted in the groups exposed to hyperbaric oxygen at 2.5 atm abs. for 2 h on the 5th and 8th days of gestation (1/26, 7/42), and all the groups exposed daily to hyperbaric oxygen (1/58, 3/33, 2/24). These findings would seem to indicate a genetic effect of increased oxygen tension in vitro.
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PMID:Chromosomal and teratogenic effects of oxygen in the mouse. 723 75


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