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 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The use of a single lung transplant, modified with removal of the middle lobe of the donor right lung, has been described for a term neonate with respiratory distress secondary to right-sided congenital diaphragmatic hernia. The successful transplant allowed the patient to be successfully weaned from extracorporeal membrane oxygenation. Because of the early age of the patient at transplantation (3 weeks), it was unclear how the patient's left lung would develop, and there was uncertainty regarding the risk of life-time immunosuppression. By the age of 4 years, 10 months, she was demonstrating some failure to thrive, hypertension, and hirsutism, obvious side effects of chronic immunosuppression. The question was raised as to the potential for transplant pneumonectomy. A ventilation-perfusion scan demonstrated a decrease of right lung ventilation compared with the immediate postoperative period (27% versus 43%); right heart catheterization with balloon occlusion of the right main pulmonary artery suggested that the patient would tolerate right pneumonectomy. After discussion with the family, the patient underwent transplant pneumonectomy via a right posterolateral approach. Findings at the time of operation included mild to moderate adhesions as well as recurrence of the diaphragmatic hernia. She tolerated the procedure well and was discharged home on the fifth postoperative day with cessation of her immunosuppression. The immediate and medium-term success of this procedure suggests the potential for temporizing transplantation as a palliation to promote survival until the remaining native lung can provide sufficient ventilation.
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PMID:Elective transplant pneumonectomy. 957 74

Aside from recognized overgrowth syndromes, instances of visceromegaly are not uncommon at perinatal autopsy. The database of the University of Michigan Teratology Unit was screened for individual viscera exceeding the 90th centile for body and brain weight standards. The data were stratified for several maternal (hypertension, diabetes, obesity), gestational (chorioamnionitis, oligohydramnios, amniorrhaea, polyhydramnios), and fetal (body wall defect, cardiac malformation, renal malformation, diaphragmatic hernia, nonimmune hydrops, twin transfusion syndrome) characteristics and tested for statistically significant excessive numbers of heavy organs. The most striking associations were heavy adrenal glands and liver with chorioamnionitis, heavy heart with polyhydramnios and in the twin transfusion syndrome, and heavy heart and liver with nonimmune hydrops. Excessive brain weight for body weight had a number of correlations, each most likely reflecting growth restriction with sparing of brain growth.
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PMID:Correlates of prenatal visceromegaly. 978 3

This chapter presents the American Academy of Pediatrics guidelines for participation in competitive sports, and discusses several conditions that may require exclusion. These conditions include absence of paired organs, hernia, Down syndrome, hypertension, cardiac and respiratory diseases, diabetes mellitus, dermatologic infections, and neurologic disorders.
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PMID:Medical Exclusion from Sport. 1035 Jul 37

The high mortality associated with congenital diaphragmatic hernia (CDH) is due to pulmonary hypoplasia and hypertension, structural and functional abnormalities which can to some extent be ameliorated by prenatal administration of glucocorticoids. In the hypoplastic, hypertensive lungs of neonatal rats in which CDH has been induced by nitrofen, those pulmonary neuroendocrine cells (PNCs) containing calcitonin gene-related peptide (CGRP) increase in number, and it has been suggested that this might be due to inhibition of secretion of the peptide, the consequent decrease in its vasodilatory effects contributing to the hypertension. Whether this increase affects the entire population of PNCs, however, and how these cells are affected by administration of prenatal glucocorticoids, is unknown. As revealed by immunolabelling for protein gene product (PGP) 9.5, a general marker of NCs and expressed per cm2 tissue section, the total PNC population in rats with nitrofen-induced CDH was significantly greater than in controls receiving only olive oil (672 vs 375/cm2, P = 0.03) and was further increased (824 per cm2) in animals treated prenatally with dexamethasone (n = 8 in all groups). The increase in the total PNC population in rats with CDH is similar in magnitude to that described for the CGRP-containing subpopulation. Since the major role of the products of PNCs is now thought to be the regulation of development of pulmonary tissues and their response to injury, it is probable that the expansion of their population in the abnormal lungs associated with CDH is an adaptive response to pulmonary maldevelopment, a response possibly augmented by exogenous corticosteroids.
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PMID:Pulmonary neuroendocrine cells in nitrofen-induced diaphragmatic hernia and the effect of prenatal glucocorticoids. 1037 17

A 44-year-old woman who weighed 130 kg (height 158 cm, BMI 52) with a complicated psychiatric history was referred for obesity surgery because of severe sleep apnea, obesity hypoventilation syndrome with frequent pneumonias, arterial hypertension, diabetes mellitus, polyarthralgia and back pain, venous insufficiency, dysmenorrhea, severe heartburn, and incisional hernia. From childhood until 1983, she had undergone 106 operations, mainly for septic/pyemic and intra-abdominal abscesses, 86 of them under general anesthesia. In the 4 years before undergoing bariatric surgery, she had gained 40 kg, nonoperative attempts at weight reduction had failed. Some months before obesity surgery she could fall asleep while standing, and she noticed an entire loss of capacity for work. Respiratory disturbance index measured during sleep by Mesam-4 device was 68 events per hour. Preoperative controlled positive airway pressure (C-PAP) therapy was used. Vital indications for weight reduction were established. Bariatric surgical steps included six operations: (1) vertical banded gastroplasty (VBG); (2) relaparotomy with suspicion of peritonitis, no complications found; (3) hernioplasty simultaneously with panniculectomy; (4) revision and removal of additional flap because of marginal skin necrosis; (5) bilateral thigh dermatolipectomy simultaneously with right-side saphenectomy; and (6) removal of intramammary abscess. Twenty-four months after VBG, she had lost 39 kg (56.5 % EWL) and was doing rather well. Obesity-related diseases except back pain were relieved.
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PMID:Successful bariatric surgery in a patient who underwent more than 100 various operations. 1048 18

Laparoscopic adrenalectomy has gained widespread popularity for treating a variety of adrenal disorders including pheochromocytoma, but the effects of pneumoperitoneum on the hemodynamics of patients with catecholamine-secreting tumors are poorly understood. The goal of this study was to compare the effects of carbon dioxide pneumoperitoneum and tumor manipulation on the hemodynamic parameters in two groups of patients with sporadic pheochromocytomas less than 7 cm in size. Group 1 patients (n = 11) underwent lateral transabdominal laparoscopic adrenalectomy, and group 2 (n = 11) underwent adrenalectomy by the open anterior approach. The mean follow-up was 37 months in group 1 (range 26-51 months) and 52 months in group 2 (range 27-72 months). All patients undergoing laparoscopic adrenalectomy experienced intraoperative hypertension (blood pressure > or = 200/90 mmHg), as did 73% with the open approach, but the difference was not significantly different. Intraoperative hypotension (systolic blood pressure < 80 mmHg) occurred in four group 1 patients compared to six patients in group 2. Mean arterial pressure, central venous pressure, and pulmonary capillary wedge pressure were significantly higher in group 1 patients prior to tumor excision, but there was no difference in pulse, cardiac index, or left ventricle work index at any point during the procedure. There were no conversions or complications in the laparoscopic group; one patient in group 2 developed an incisional hernia. Although laparoscopic adrenalectomy for pheochromocytoma is associated with a greater increase in mean arterial pressure, central venous pressure, and pulmonary capillary wedge pressure, the creation of pneumoperitoneum does not significantly change the cardiac index or left ventricle work index. Carbon dioxide pneumoperitoneum is well tolerated in patients with pheochromocytoma.
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PMID:Comparison of the hemodynamic parameters of open and laparoscopic adrenalectomy for pheochromocytoma. 1078 79

This article evaluates the results of single vessel bypass surgery for symptomatic chronic mesenteric ischaemia (CMI) in 6 patients undergoing a total of 8 superior mesenteric artery (SMA) bypass operations, all with good post-operative symptom relief. Post-prandial pain and weight loss was present in 5 out of 6 patients. Epigastric bruit was present in only two patients and 4 out of 6 patients had diarrhoea. The patients had varying degrees of peripheral vascular disease, ischaemic heart disease and hypertension. All patients had occlusion of the SMA on angiography and bypassing the occluded segment resulted in disappearance of the symptoms and weight gain. The vascular graft was sutured end to side to the front of the infra-renal aorta and end to side to the SMA, distal to the origin of the middle colic artery. Two patients had recurrence of symptoms due to graft occlusion at 3 and 4 years, respectively; they were successfully treated with repeat SMA bypass. There were no major complications or deaths related to the procedure in this study; one patient developed an incisional hernia requiring elective repair. Thus, early restoration of SMA circulation by bypass grafting in patients with CMI is sufficient to alleviate symptoms and prevent intestinal infarction with its high mortality rate.
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PMID:Superior mesenteric artery bypass for chronic mesenteric ischaemia: a DGH experience. 1107 74

A case of gravid uterus in an incisional hernia is reported. The pregnancy was further complicated by intrauterine growth restriction, oligohydramnios and pregnancy induced hypertension. The management of the case is discussed.
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PMID:Gravid uterus in an incisional hernia. 1139 42

This article gives an overview, citing animal and clinical studies, of the effects of increased intra-abdominal pressure (IAP) in severe obesity. Animal studies demonstrate that increased IAP increases pleural pressure, cardiac filling pressures, femoral venous pressure, renal venous pressure, systemic blood pressure, and vascular resistance, renin and aldosterone levels, and intracranial pressure. Thus, the comorbidities presumed secondary to increased IAP in obese patients include congestive heart failure, hypoventilation, venous stasis ulcers, gastroesophageal reflux, urinary stress incontinence, incisional hernia, pseudotumor cerebri, proteinuria, and systemic hypertension.
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PMID:Effects of increased intra-abdominal pressure in severe obesity. 1158 45

Congenital diaphragmatic hernia (CDH) is a life-threatening anomaly with a significant mortality rate. Despite widespread prenatal diagnosis, few parameters have been well defined to aid in prediction of outcome of these infants. Antenatal maternal steroid administration and foetal surgery are not proven interventions. Postnatal treatment has changed over the last 10 years, with avoidance of hyperventilation and ventilator-induced lung injury resulting in improved survival. Therapies such as inhaled nitric oxide, exogenous surfactant administration and extracorporeal membrane oxygenation (ECMO) have undergone limited study, but show no clear benefit in this population. With improved outcome, principally due to avoidance of barotrauma, greater opportunity exists for long-term evaluation of survivors. To date, continuing problems with pulmonary function, nutrition and growth, effects of right ventricular hypertension and developmental issues have been identified. Through co-ordinated, multidisciplinary evaluation of CDH survivors, improved long-term outcome for these challenging patients can be attained.
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PMID:Current therapy of infants with congenital diaphragmatic hernia. 1500 Nov 40


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