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

The authors evaluated the safety and efficacy of liquid ventilation with perfluorocarbon in four newborns with congenital diaphragmatic hernia and severe respiratory failure, who were on extracorporeal life support (ECLS). After 2 to 5 days on the ECLS, perflubron was administered into the trachea until the dependent zone of the lung was filled. The first dose was 6 +/- 1 mL/kg (range, 5 to 8 mL/kg). Gas ventilation of the perflubron-filled lung was performed (partial liquid ventilation). The administration of perflubron was repeated daily for 5 to 6 days, with total cumulative doses of 36 +/- 8 mL/kg (range, 26 to 44 mL/kg). A significant increase in PaO(2) (P = .027 by repeated-measures analysis of variance [ANOVA]), a trend toward an increase in arterial oxygen content (P = .052 by repeated-measures ANOVA), and a significant increase in specific static total pulmonary compliance (P = .007 by repeated-measures ANOVA) were observed after administration of the daily dose of perflubron. PaCO(2) data showed a decreasing trend (P = .08 by repeated measures ANOVA). The authors conclude that perflubron can be safely administered into the lungs of newborn patients with congenital diaphragmatic hernia and severe respiratory failure, and it may be associated with improvement in gas exchange and pulmonary compliance.
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PMID:Partial liquid ventilation in newborn patients with congenital diaphragmatic hernia. 886 66

The long-term follow-up of patients operated on for congenital diaphragmatic hernia (CDH) at birth has been extensively evaluated, both clinically and with respect to respiratory function. However, little is known about the sports practice and stress performance of these subjects. Fifteen of 107 patients operated on for CDH underwent exercise stress testing with a stepwise increase in workload. A questionnaire was provided, which requested information on sports practice and lifestyle. Maximal oxygen consumption [Vo2 max] was measured along with dynamic lung volumes. Clinical examination included a whole-body assessment (height, weight, skinfolds) and vital parameters (heart rate and blood pressure). Fifteen healthy children who practiced regular physical activity (2 to 4 hours/week) served as controls. All the CDH patients experienced a good lifestyle, but only 8 of them were participating in sports. Exercise duration and Vo2 max were significantly lower for the CDH patients, and were lowest for the sedentary patients. Therefore, the reduced Vo2 max of these otherwise healthy children most likely represents a lower degree of physical fitness rather than decreased respiratory function. Fitness is an expression of well-being; thus, there is evidence that these patients could safely participate in competitive motor activities.
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PMID:Maximal oxygen consumption and stress performance in children operated on for congenital diaphragmatic hernia. 886 41

Venovenous (VV) extracorporeal membrane oxygenation (ECMO) using a double lumen catheter has become an accepted method of providing ECMO support for critically ill newborn infants. In addition, use of the cephalic jugular catheter can provide augmented venous blood flow, potentially prevent increased cerebral venous pressure, maintain cerebral venous blood flow, and increase ECMO oxygen delivery. The authors compared their experience using VV double-lumen (VVDL) ECMO with a cephalic jugular catheter with their previous experience using venoarterial (VA) ECMO. They compared 15 infants who had meconium aspiration syndrome (MAS) and 12 who had congenital diaphragmatic hernia (CDH) treated with VVDL ECMO with a cephalic jugular catheter with the same number of infants with each condition treated with VA ECMO (historical controls). There were no significant differences between the groups with respect to birth weights, oxygen indexes before ECMO, of ECMO flows at 4 and 24 hours. For infants with MAS treated with VVDL ECMO, the overall duration of ECMO support was significantly shorter (63 hours VVDLv 118 hours VA; P = .001), and the average cephalic flow was 33 mL/kg for infants treated with VVDL support. For infants with CDH, there were no differences in any of the variables evaluated, including total duration (100 hours VVDLv 128 hours VA; P = .06 [NS]), and the average cephalic flow was 39 mL/kg for infants treated with VVDL support. The venous oxygen content was significantly lower in infants with MAS treated with VVDL ECMO than for historical controls treated with VA ECMO at 4 hours of ECMO support (15.8 v 16.7; P < or = .05). No other significant differences were noted for any of the calculated oxygen transport variables comparing VVDL with VA ECMO infants with CDH treated with VVDL ECMO were extubated sooner than those treated with VA ECMO (10.3 days VVDL v 15.4 days VA; P = 048). In addition, there was no significant difference in the overall incidence of complications or death. This experience suggests that VVDL ECMO using a cephalic jugular catheter results in shorter ECMO runs and provides support that is comparable to VA ECMO for infants with CDH and MAS while avoiding carotid artery cannulation and ligation.
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PMID:Venovenous extracorporeal membrane oxygenation: the effects of proximal internal jugular cannulation. 890 69

Several factors suggested to predict mortality in congenital diaphragmatic hernia (CDH) have not always been applicable in different centers. A retrospective review was conducted of 19 consecutive neonates in Singapore in whom CDH was diagnosed within 12 hours of birth to identify factors associated with mortality. Of the 19 cases, 15 (79%) were diagnosed using antenatal ultrasonography. Eight (42%) underwent primary repair at a median age of 23 hours (range, 12 to 50 hours). Of the 19 infants, 15 died (mortality rate, 79%). Survivors until hospital discharge were compared with nonsurvivors. Antenatal diagnosis and stomach position in left-sided defects had no effect on outcome, although polyhydramnios tended to be associated with nonsurvival. Significant postnatal factors associated with mortality included a low arterial pH level, low initial arterial-alveolar oxygen ratio, high initial alveolar-arterial oxygen gradient, as well as high oxygenation and ventilation indices. These results reflect difficulty in oxygenation because of pulmonary hypoplasia despite evidence of adequate ventilation. There was no difference between survivors and nonsurvivors in either their initial or best postductal blood gases. The "Bohn quadrants" did not aid in predicting survival of infants who underwent repair because all eight such infants had best postductal carbon dioxide values of less than 40 mm Hg and ventilation indices of less than 1,000. Yet only four (50%) survived until hospital discharge. Large-scale evaluation of these factors may be required in the future to demonstrate their validity and reliability because of changing management strategies for CDH.
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PMID:Mortality among infants with high-risk congenital diaphragmatic hernia in Singapore. 902 80

Pneumothorax was identified as a complication of endoscopic hernia repair in two patients with insufflation pressures of 15 mmHg and operating times exceeding 2 h. These patients also showed intraoperative perturbations in both oxygen saturation and end-tidal CO2 production. A prospective study was undertaken to determine whether similar complications would arise if preperitoneal insufflation pressures were limited to 10 mmHg. Postoperative chest x-rays were obtained on all patients to check for pneumothoraces, even clinically occult ones. Fifty patients were studied, with average operating times of 67 min. No patient demonstrated any hemodynamic or ventilatory changes, and none had any evidence of pneumothorax on x-ray. We conclude that these complications were not present when insufflation pressure was maintained at 10 mmHg and that routine x-ray is not warranted. Larger randomized trials of insufflation pressures are needed.
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PMID:Pneumothorax as a complication of laparoscopic inguinal hernia repair. 906 49

We studied severity and prognosis of congenital diaphragmatic hernia (CDH) by using preductal arterial blood gas analysis (BGA) and pulmonary function tests (PFTs) in 29 newborn infants. CDH was diagnosed within 24 hours of life, and surgical repair was performed through an abdominal approach after a period of stabilization. The infants were classified into the following three groups based on the highest preoperative alveolar-arterial oxygen tension difference (A - aDO2) and the lowest arterial carbon dioxide pressure (PaCO2) values; Group A (n = 15) : A - aDO2 < 500 mmHg, PaCO2 < 40 mmHg, Group B (n = 7) : A - aDO2 > or = 500 mmHg, PaCO2 < 40 mmHg, Group C (n = 7) : A - aDO2 > or = 500 mmHg, PaCO2 > or = 40 mmHg. Furthermore, the patients were classified into the following three groups based on the preoperative respiratory system compliance (Crs) and forced vital capacity (FVC) values; Group D (n = 8) : Crs < 0.5 ml.cmH2O-1.kg-1, FVC < 10 ml.kg-1, Group E (n = 4) : Crs < 0.5 ml.cmH2O-1.kg-1, FVC > or = 10 ml.kg-1, Group F (n = 17) : Crs > or = 0.5 ml.cmH2O-1.kg-1, FVC > or = 10 ml.kg-1. The mortality in the Group C was significantly higher than in the Group A and B, and the preoperative Crs and FVC values in the Group C were significantly lower than the other groups. The mortality in the Group D and E were significantly higher than the Group F. In conclusion, it is suggested that the preoperative Crs value less than 0.5 ml.cmH2O-1.kg-1 indicates severe pulmonary hypoplasia and is critical for survival.
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PMID:[Severity and prognosis of congenital diaphragmatic hernia from the viewpoint of perioperative respiratory function]. 922 90

The response to three levels (10 ppm, 20 ppm and 40 ppm) of nitric oxide (NO) was assessed in 30 infants, median gestational age 30 (range 24-42) weeks. All the infants required an inspired oxygen concentration of more than 0.5, despite receiving surfactant where appropriate. All but one infant had a positive response to NO (median reduction in the oxygenation index (OI) was 33%, range -9%-90%), but only 20 infants showed a greater than 20% reduction in the OI. There was no obvious relationship of the optimum NO level (i.e. that associated with the maximum reduction in OI) and either diagnosis (congenital diaphragmatic hernia, meconium aspiration syndrome, respiratory distress syndrome, pulmonary interstitial emphysema (PIE), hydrops and sepsis) or maturity, except that five of six infants with PIE responded best to 40 ppm, as did eight of nine infants less than 28 weeks gestational age. We conclude NO dosage should be individualized and NO levels up to 40 ppm should be considered in very immature infants.
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PMID:Response to nitric oxide in term and preterm infants. 926 98

The vasodilator molecule nitric oxide is critically involved in the successful cardiopulmonary transition from fetal to postnatal life. It is produced in the pulmonary endothelium by the endothelial isoform of the enzyme nitric oxide synthase. The expression of endothelial nitric oxide synthase in the lung increases dramatically during late gestation, optimizing the capacity for nitric oxide production at the time of birth. Studies in cultured cell models indicate that the developmental upregulation may be mediated by estrogen, and that the expression of the enzyme is also upregulated by oxygen. Pulmonary endothelial nitric oxide synthase expression is diminished in models of congenital diaphragmatic hernia and neonatal pulmonary hypertension induced by fetal ductal ligation. Thus, there is normally a marked developmental upregulation in endothelial nitric oxide synthase expression in the lung during late fetal life, and attenuated expression of the enzyme may contribute to the pathophysiology of a variety of forms of neonatal pulmonary vascular disease.
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PMID:Ontogeny of nitric oxide in the pulmonary vasculature. 935 11

Extracorporeal life support and extracorporeal membrane oxygenation characterize the use of mechanical devices for temporary support of heart and lung function. The mechanical circuit consists of a blood pump (heart), membrane oxygenator (lung: which accomplishes both carbon dioxide removal and oxygen delivery), heat exchanger and a servo-control module. Venous blood is drained from the right atrium through the right internal jugular vein, and returned oxygenated through either the right common carotid artery (venoarterial bypass), or into a large vein (venovenous bypass). All patients treated must be free of coagulopathies, as all patients are anticoagulated. Neonatal candidates should be older than 34 weeks gestational age and weigh more than 2000 grams. As of March, 1997 twenty six patients have been treated with extracorporeal life support at Tulane Medical Center with an overall survival rate of 62%. Twelve neonates with either meconium aspiration or pneumonia have been treated with a 100% survival. Six children with congenital diaphragmatic hernia have been unsuccessfully treated.
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PMID:[Extracorporeal membrane oxygenation in neonatology: review of the use of the method]. 952 22

A cohort of survivors of congenital diaphragmatic hernia (CDH), with matched controls, was studied to assess growth, respiratory function, and exercise performance. Nineteen of 24 survivors from an 11 year period (79%) were compared with 19 matched controls. Subjects had detailed auxology, performed spirometry and cycle ergometry, and completed questionnaires about respiratory symptoms and exercise. There were no significant differences between the groups for height, weight, sitting height, head circumference, or body mass index expressed as SD scores. The mean (95% confidence interval) percentage predicted forced vital capacity (FVC) was 84.7% (79.1 to 90.3) in index cases and 96.5% (91.4 to 101.6) in controls (p < 0.01). There was no significant difference in total lung capacity. Expiratory flow rates corrected for FVC were also similar between groups, suggesting normal airway function relative to lung size. Mean maximum oxygen consumption in ml/kg/min was 40.1 (36.8 to 43.4) and 42.2 (38.5 to 45.8) in index and control cases. These differences were not significant. Index cases achieved a similar minute ventilation to controls by more rapid and shallower breathing. Index cases had lower perception of their own fitness and lower enjoyment of exercise, although habitual activity levels were similar. Survivors of CDH repair have reduced functional lung volumes, but normal airway function compared with matched controls. They have no growth impairment nor significant impairment of exercise performance, although they have more negative perceptions of their own fitness. They should be encouraged and expected to participate fully in sport and exercise.
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PMID:Pulmonary function, exercise performance, and growth in survivors of congenital diaphragmatic hernia. 957 55


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