MedWorm: Congenital Diaphragmatic Hernia Repair

The use of endoscopy in fetal medicine

Gynecological Surgery — Wed, 10 Mar 2010 18:29:46 +0100

Abstract We aimed to review the state of affairs in the field of embryo–fetoscopy as well as its instrumental requirements. Today, endoscopic procedures of limited complexity are easily possible within the amniotic cavity. Embryoscopy is typically done for diagnostic purposes, such as the demonstration of external anomalies very early in pregnancy and/or obtaining embryonic tissues in recurrent miscarriages. Fetoscopy is the direct visualization of the amniotic cavity from the second trimester onwards. Its principal indications are complications of monochorionic twinning and severe congenital diaphragmatic hernia. There is level I evidence that fetoscopic laser surgery for twin–twin-transfusion syndrome is superior over amniodrainage. Fetoscopic endoluminal tracheal oc...

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Respiratory distress associated with inadequate mechanical ventilator flow response in a neonate with congenital diaphragmatic hernia.

Respiratory Care — Mon, 01 Mar 2010 00:00:00 +0100

We report a neonate who was born with a left congenital diaphragmatic hernia and underwent surgical repair. The lack of ventilator flow response and flow cycling was identified via interpretation of the ventilator graphic and clinical assessment. Presumably, the ventilator failed to respond to the patient's peak inspiratory flow demand, despite the clinician's setting the highest peak flow available. A time-cycled pressure-limited mode with adjustable peak flow rate was the only option that met the infant's flow requirement, and alleviated the respiratory distress. This clinical finding follows bench research that raises the concern that so called "cradle-to-grave" ventilators may not optimally support all neonates. PMID: 20196885 [PubMed - in process] (Source: Respiratory Care)

Journal of Pediatric Surgery — Mon, 01 Mar 2010 00:00:00 +0100

On behalf of the CDH Euro-Consortium, this review gives an overview of the disease spectrum of congenital diaphragmatic hernia (CDH). Etiologic factors, prenatal predictors of survival, new treatment strategies, and long-term morbidity are described. Early recognition of problems and improvement of treatment strategies in CDH patients may increase survival and prevent secondary morbidity. Multidisciplinary health care is necessary to improve health care for CDH patients. Absence of international therapy guidelines, lack of evidence of many therapeutic modalities, and the relatively low number of CDH patients call for cooperation between centers with an expertise in the treatment of CDH patients. To study these problems, the international CDH Euro-Consortium was started in 2006 to enhance c...

Journal of Pediatric Surgery — Mon, 01 Mar 2010 00:00:00 +0100

The loss of normal anatomical barriers in neonates with congenital diaphragmatic hernia (CDH) can predispose children to gastroesophageal reflux (GER). In an attempt to improve postoperative feeding, the authors have added a modified anterior fundoplication to restore natural gastric and esophageal positioning. (Source: Journal of Pediatric Surgery)

Lung volumes, ventricular function and pulmonary arterial flow in children operated on for left-sided congenital diaphragmatic hernia: long-term results

European Radiology — Wed, 17 Feb 2010 06:53:38 +0100

Conclusion Functional MRI detected pulmonary and cardiac findings in the late follow-up of CDH children which may be missed by standard clinical methods and might be relevant for decisions regarding late outcome and treatment. Content Type Journal ArticleCategory PediatricDOI 10.1007/s00330-010-1723-9Authors Nasreddin Abolmaali, Dresden University of Technology OncoRay - Molecular and Biological Imaging, Medical Faculty Carl Gustav Carus Fetscherstraße 74 PF 86 Dresden GermanyArne Koch, Dresden University of Technology OncoRay - Molecular and Biological Imaging, Medical Faculty Carl Gustav Carus Fetscherstraße 74 PF 86 Dresden GermanyKnut Götzelt, University Clinics Carl Gustav Carus, Dresden University of Technology Clinic and Policlinic for Pediatrics - Pediatri...

Significance and outcome of left heart hypoplasia in fetal congenital diaphragmatic hernia

Ultrasound in Obstetrics and Gynecology — Tue, 09 Feb 2010 00:00:00 +0100

The objective of this study was to investigate whether small left heart dimensions prenatally normalize after birth in patients with CDH, or whether prenatal indices of left heart size and flow predict postnatal outcome.Clinical and echocardiographic data were reviewed for patients diagnosed with left-sided CDH prenatally. Cardiac dimensions and flows were compared with normative data. Among liveborn patients, pre- and postnatal Z-scores of left heart structures were compared, and associations between prenatal indices and outcome were assessed.Of 125 patients diagnosed prenatally with CDH, 111 had a left-sided defect. Of these, 85 were liveborn, including 20 with congenital heart disease. Gestational age-adjusted dimensions of fetal left heart structures, including aortic valve diameter, m...

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Thoraco-abdominal mature teratoma in a left diaphragmatic hernia

Indian Journal of Pediatrics — Mon, 08 Feb 2010 15:19:50 +0100

Abstract This case describes a contiguous mediastinal and retroperitoneal mature teratoma in a congenital diaphragmatic defect, a combination that is hitherto unreported in literature. It substantiates embryological chronology of events during the cephalad migration of the primordial germ cells through the developing diaphragm, prior to its closure. Content Type Journal ArticleCategory Clinical BriefDOI 10.1007/s12098-010-0020-6Authors Suhasini Gazula, Department of Pediatric Surgery New Delhi IndiaSandeep R. Mathur, Department of Pathology New Delhi IndiaVenkateswaran K. Iyer, Department of Pathology New Delhi IndiaArun K. Gupta, Department of Radiodiagnosis New Delhi IndiaDilip K. Pawar, Department of Anesthesiology New Delhi IndiaSandeep Agarwala, Department of Pediatr...

Significance and outcome of left heart hypoplasia in fetal congenital diaphragmatic hernia.

The Ultrasound Review of Obstetrics and Gynecology — Mon, 08 Feb 2010 00:00:00 +0100

CONCLUSIONS: Hypoplasia of and reduced flow through the left heart are common among fetuses with CDH. After birth and CDH repair, left heart dimensions generally normalize, with adequate size to support a biventricular circulation, even when there is very low flow through the left heart in mid- and late-gestation. Copyright (c) 2010 ISUOG. Published by John Wiley & Sons, Ltd. PMID: 20143332 [PubMed - as supplied by publisher] (Source: The Ultrasound Review of Obstetrics and Gynecology)

Robot-Assisted Pediatric Surgery: How Far Can We Go?

World Journal of Surgery — Wed, 03 Feb 2010 06:47:49 +0100

Conclusions Robot-assisted surgery appears to be safe and feasible for a number of pediatric surgical procedures. Further system improvement and randomized studies are required to evaluate the benefits, if any, and the long-term outcomes of robotic surgery. Content Type Journal ArticleDOI 10.1007/s00268-010-0431-6Authors Aayed Alqahtani, King Saud University Division of Pediatric Surgery, College of Medicine P.O. Box 84147 Riyadh 11671 Saudi ArabiaAbdullrahman Albassam, King Saud University Division of Pediatric Surgery, College of Medicine P.O. Box 84147 Riyadh 11671 Saudi ArabiaMohammed Zamakhshary, King Saud bin Abdulaziz University for Health Sciences Division of Pediatric Surgery Riyadh Saudi ArabiaMohammed Shoukri, King Saud University Division of Pediatric Surge...

Is there a role for antioxidants in prevention of pulmonary hypoplasia in nitrofen-induced rat model of congenital diaphragmatic hernia?

Pediatric Surgery International — Tue, 02 Feb 2010 17:47:04 +0100

Conclusion Prenatal administration of NAC and vitamin E in combination with vitamin C represented the best effects to avoid oxidative damage and protein content of the lungs in rat pups with CDH at birth. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00383-010-2552-2Authors Murat Kemal Cigdem, Medical School, Dicle University Department of Pediatric Surgery 21280 Diyarbakir TurkeyGoksel Kizil, Science School, Dicle University Department of Chemistry Diyarbakir TurkeyAbdurrahman Onen, Medical School, Dicle University Department of Pediatric Surgery 21280 Diyarbakir TurkeyMurat Kizil, Science School, Dicle University Department of Chemistry Diyarbakir TurkeyYusuf Nergiz, Medical School, Dicle University Department of Histology Diyarbakir TurkeyYusuf C...

Thoracoscopic repair of congenital diaphragmatic hernia: intraoperative ventilation and recurrence

Journal of Pediatric Surgery — Mon, 01 Feb 2010 00:00:00 +0100

Conclusion: Thoracoscopic repair of CDH is feasible. Arterial blood gases should be closely monitored. Despite higher EtCO2, conversion to open was mainly because of difficult repair. A randomized trial is necessary to assess the effect of thoracoscopy on ventilation and recurrences. (Source: Journal of Pediatric Surgery)

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Bronchopulmonary innervation defects in infants and rats with congenital diaphragmatic hernia

Journal of Pediatric Surgery — Mon, 01 Feb 2010 00:00:00 +0100

Conclusions: The lungs of infants and rats with CDH have decreased neural components compensated by increased supporting glial cells and persistence high expression of RET and GDNF protein. Because bronchopulmonary innervation controls airway smooth muscle, vessels, and glandular secretions, it is tempting to hypothesize that these deficiencies might play a role in respiratory morbidity in CDH. (Source: Journal of Pediatric Surgery)

Spatiotemporal alteration in phosphatidylinositide 3-kinase–serine/threonine protein kinase B signaling in the nitrofen-induced hypoplastic lung

Journal of Pediatric Surgery — Mon, 01 Feb 2010 00:00:00 +0100

Conclusion: Spatiotemporal alteration of pulmonary PI3K and AKT gene and protein expression during epithelial morphogenesis may interfere with epithelial-mesenchymal interaction, causing pulmonary hypoplasia in CDH by disrupting PI3K-AKT signaling pathway. (Source: Journal of Pediatric Surgery)

Diagnosis and management of fetal intrapericardial Morgagni diaphragmatic hernia with massive pericardial effussion

Journal of Pediatric Surgery — Mon, 01 Feb 2010 00:00:00 +0100

We report an early antenatal diagnosis of congenital diaphragmatic hernia of Morgagni with pericardium effussion at 21 weeks' gestation. Two pericardiocentesis were performed at 21 and 22 4/7 weeks' gestation because of recurrence of pericardial effussion. Regular ultrasound assessments showed progressive herniation of the liver to practically fill the right hemithorax. An ex utero intrapartum treatment procedure was performed at 37 weeks' gestation to rescue maximum intrathoracic space for ventilation of the remaining functional lung tissue and to establish an airway for postnatal support. After birth, the patient successfully underwent early correction of the hernia. Postoperative course was uneventful, and the newborn girl was discharged 18 days later without complications and is curren...

Outcome of Congenital Diaphragmatic Hernia Repair Depending on Patch Type

Journal of Surgical Research — Mon, 25 Jan 2010 16:42:02 +0100

Introduction: Repair of the congenital diaphragmatic hernia when a patch is required is associated with a much higher recurrence rate then when primary repair is feasible. The biosynthetic options for the material used in the repair of these large defects continues to expand. Therefore, we reviewed our experience to benchmark the complication rates of each option as we move forward with new materials. Methods: After obtaining IRB approval, a retrospective review was conducted on all patients who underwent repair of congenital diaphragmatic hernia from January, 1994 to May, 2009. Data recorded included demographics, type of repair, recurrence, small bowel obstruction (SBO) and subsequent abdominal operations after repair. Non-survivors were defined as those who died within three months and ...

A Repair Technique and Patch Material Designed to Reduce Recurrence of Congenital Diaphragmatic Hernia

Journal of Surgical Research — Mon, 25 Jan 2010 16:41:02 +0100

Conclusions: 1) These results suggest a reinforced (pledget) non-absorbable suture repair technique may contribute to the reduction of CDH recurrence. 2) When a patch is needed, woven Dacron is strong, supple, and favors tissue in-growth which eventually stiffens it. These characteristics also seem helpful in reducing recurrences. In contrast, the two commonly used materials, Gore-Tex which is initially unyielding, difficult to sew, and does not heal with tissues, and multi-layer tissue patches which lack strength, seem less suitable. 3) The rim of diaphragm originally present appears capable of normal growth and this potential would seem to make patch growth or muscle transfer unnecessary. When the patient is fully grown, even a relatively large Dacron patch initially will comprise only a...

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Resource Utilization for Congenital Diaphragmatic Hernia in the United States

Journal of Surgical Research — Mon, 25 Jan 2010 16:41:02 +0100

Purpose: Using total hospital charges as a surrogate, we sought to profile resource utilization for newborns with congenital diaphragmatic (CDH) in the United States. Methods: The Kids' Inpatient Database (1997-2006) was analyzed for all patients with CDH admitted at (Source: Journal of Surgical Research)

Congenital Diaphragmatic Hernia in the Preterm Infant: A Report from the Congenital Diaphragmatic Hernia Study Group

Journal of Surgical Research — Mon, 25 Jan 2010 16:40:00 +0100

Background: Congenital Diaphragmatic Hernia (CDH) remains a significant cause of death in the newborn. With preoperative stabilization strategies and advances in neonatal critical care, survival in the term infant now approaches 70%.Although prematurity is the most significant risk factor for morbidity and mortality in most neonatal diseases, its impact on infants with CDH has been poorly described. We evaluated the outcomes of preterm ( (Source: Journal of Surgical Research)

What Causes Respiratory Distress?

PediatricEducation.org — Mon, 25 Jan 2010 00:01:37 +0100

Discussion Pectus excavatum is a deformation of the chest wall where the sternum and ribs grow abnormally to form a concavity relative to normal positioning. Pectus carnitum is similar but forms a convexity. Pectus excavatum is much more common (90%) than pectus carnitum (7-8%) or other congenital chest wall deformities (2-3%). Pectus excavatum is usually noted at birth or in the first year of life. It may be relatively minor (the most common) or quite severe (rarer) with the concavity displacing internal organs and possibly causing pulmonary and/or cardiac abnormalities. Usually it is relatively stable, but may progress especially during times of rapid growth such as puberty. Thankfully most patients do not need treatment but severe pectus excavatum may cause psychological distress becaus...

Congenital mesenteric abnormality causing death in an infant with a concurrent diaphragmatic hernia

Forensic Science, Medicine, and Pathology — Mon, 18 Jan 2010 18:25:07 +0100

Abstract The principle causes of infant death are natural causes [including the Sudden Infant Death Syndrome (SIDS)]. Natural deaths in infants are principally due to infections, cardiovascular anomalies and other metabolic or genetic disorders. Gastrointestinal pathology including anomalies may also cause death in this age group. This case describes a 6 month old boy who had undergone repair of a diaphragmatic hernia when aged 2 days, but who subsequently died as a result of a mesenteric abnormality with torsion of the gut and a large fibrous walled bowel containing hernial sac in the left pleural cavity. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s12024-009-9135-3Authors Jonathon Herbst, Forensic Science South Australia 21 Divett Place Adela...

Thoracoscopic Repair of Congenital Diaphragmatic Hernia in Infancy

Journal of Laparoendoscopic — Mon, 11 Jan 2010 00:04:46 +0100

Journal of Laparoendoscopic & Advanced Surgical Techniques , Vol. 0, No. 0. (Source: Journal of Laparoendoscopic)

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Right congenital diaphragmatic hernia associated with anorectal malformation

Journal of Pediatric Surgery — Thu, 31 Dec 2009 15:18:39 +0100

We describe a neonate in whom a right congenital diaphragmatic hernia and an anorectal malformation coexisted. Their coexistence in the same patient is rare. (Source: Journal of Pediatric Surgery)

Hepatic pulmonary fusion in an infant with a right-sided congenital diaphragmatic hernia and contralateral mediastinal shift

Journal of Pediatric Surgery — Thu, 31 Dec 2009 15:18:31 +0100

Abstract: Hepatic pulmonary fusion is extremely rare with only 9 previous cases reported in the literature. In typical cases, the clinician should be alerted to the possibility of hepatic pulmonary fusion if the chest radiograph shows a large opacity on the right side without a contralateral mediastinal shift. The authors present a case of right-sided diaphragmatic hernia and hepatic pulmonary fusion with associated contralateral mediastinal shift discovered beyond the neonatal period. The 9 previous cases were retrospectively reviewed with special attention to mediastinal shift on preoperative chest radiograph, operative procedure, and mortality. Only one previous case demonstrated a contralateral mediastinal shift. The most common procedure performed was partial separation of the hepatic...

Long-term surgical outcomes in congenital diaphragmatic hernia: observations from a single institution

Journal of Pediatric Surgery — Thu, 31 Dec 2009 15:18:29 +0100

Conclusions: For long-term survivors of CDH, specific perinatal and operative variables, particularly patch repair, are associated with subsequent adverse surgical outcomes. (Source: Journal of Pediatric Surgery)

Outcomes after muscle flap vs prosthetic patch repair for large congenital diaphragmatic hernias

Journal of Pediatric Surgery — Thu, 31 Dec 2009 15:18:28 +0100

Conclusion: These results suggest that autologous anterior abdominal wall muscle flap and prosthetic patch repairs provide similar short-term and long-term outcomes. (Source: Journal of Pediatric Surgery)

Up-regulation of Wnt5a gene expression in the nitrofen-induced hypoplastic lung

Journal of Pediatric Surgery — Tue, 01 Dec 2009 00:00:00 +0100

Conclusion: Up-regulation of pulmonary Wnt5a gene expression in the late lung morphogenesis may interfere with patterning of alveolarization, causing pulmonary hypoplasia in the nitrofen-induced CDH. (Source: Journal of Pediatric Surgery)

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A unique case of a congenital diaphragmatic hernia in a boy with albinism

Journal of Pediatric Surgery — Tue, 01 Dec 2009 00:00:00 +0100

This report describes a unique case of a male Asian baby with oculocutaneous albinism and a right-sided congenital diaphragmatic hernia. (Source: Journal of Pediatric Surgery)

Two new approaches in intrauterine tracheal occlusion using an ultrathin fetoscope

The Laryngoscope — Mon, 30 Nov 2009 00:00:00 +0100

To introduce and establish a new approach in minimal invasive fetoscopic surgery in order to reduce access trauma and the iatrogenic preterm premature rupture of the membranes (PPROM) as a major complication of intrauterine treatment of congenital diaphragmatic hernia.In total, 27 pregnant sheep were operated on using fetoscopes with 1.2 and 1.0 mm optics. We used an elliptic sheath alone with a maximum diameter of 2.6/1.3 mm; in these cases the balloon was placed under ultrasound control. In comparison, we placed the balloon under fetoscopic control using the fetoscopic sheath and a 7F (2.3 mm) introducer. Therefore, the maximum access trauma was not bigger than the diameter of sheath of introducer.With this technique we successfully operated on 22 sheep. The use of real time three-dimens...

Fetal surgery is a clinical reality

Seminars in Fetal and Neonatal Medicine — Mon, 16 Nov 2009 00:00:00 +0100

Summary: An increasing number of fetal anomalies are being diagnosed prior to birth, some of them amenable to fetal surgical intervention. We discuss the current clinical status and recent advances in endoscopic and open surgical interventions. In Europe, fetoscopic interventions are widely embraced, whereas the uptake of open fetal surgery is much less. The indications for each access modality are different, hence they cannot substitute each other. Although the stage of technical experimentation is over, most interventions remain investigational. Today there is level I evidence that fetoscopic laser surgery for twin-to-twin transfusion syndrome is the preferred therapy, but this operation actually takes place on the placenta. In terms of surgery on the fetus, an increasingly frequent indi...

Tracheomegaly: a complication of fetal endoscopic tracheal occlusion in the treatment of congenital diaphragmatic hernia

Pediatric Radiology — Thu, 05 Nov 2009 19:04:41 +0100

Conclusion There are no previous reports in the literature describing tracheomalacia, or more specifically, tracheomegaly, as a consequence of FETO. We propose that the particularly compliant fetal airway is at risk of mechanical damage from in utero balloon occlusion. This observation of a new problem in this cohort suggests a thorough evaluation of the trachea should be performed in children who have had FETO in utero. It may be that balloon occlusion of the trachea earlier in utero (before 26 weeks’ gestation) predisposes to this condition. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00247-009-1437-9Authors Kieran McHugh, Great Ormond Street Hospital for Children Radiology Department London WC1N 3JH UKAsim Afaq, Great Ormond Street Ho...

Preface

Thoracic Surgery Clinics — Sun, 01 Nov 2009 00:00:00 +0100

The integrity and function of the diaphragm is essential to life because of its role in respiration. It is similar to the heart in that the muscle of the diaphragm must contract continuously throughout life. Any breach or dysfunction of the diaphragm may be a threat to life; hence, a thorough knowledge of the anatomy, physiology, and conditions of the diaphragm are essential to the practice of thoracic surgery. Thoracic surgeons must be able to repair or reconstruct the diaphragm when its integrity is breached by congenital abnormalities, acquired hernias, trauma, tumors, or surgical incisions. In acquired conditions that diminish diaphragmatic function, thoracic surgeons may be required to surgically modify the diaphragm to improve function. Knowledge of the innervation of the diaphragm a...

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Surgical Conditions of the Diaphragm: Posterior Diaphragmatic Hernias in Infants

Thoracic Surgery Clinics — Sun, 01 Nov 2009 00:00:00 +0100

This article reviews the diagnosis and management strategies of congenital diaphragmatic hernia and the outcomes of congenital diaphragmatic hernia patients. (Source: Thoracic Surgery Clinics)

Congenital Diaphragmatic Hernia in the Adult

Thoracic Surgery Clinics — Sun, 01 Nov 2009 00:00:00 +0100

Congenital diaphragmatic herniae (CDH) are uncommon in neonates and extremely rare in adults. The clinical presentation of CDH in adults tends to be very different from neonates. Many adults remain asymptomatic and CDH are diagnosed incidentally. All CDH should be repaired. Minimally invasive surgical approaches are now gaining popularity for the repair of CDH with excellent outcomes. (Source: Thoracic Surgery Clinics)

Upregulation of Slit-2 and Slit-3 gene expressions in the nitrofen-induced hypoplastic lung

Journal of Pediatric Surgery — Sun, 01 Nov 2009 00:00:00 +0100

Conclusion: Our results provide evidence, for the first time, that Slit genes are upregulated in nitrofen-induced hypoplastic lungs in both early and late stages of lung development. Altered pulmonary Slit gene expression may disrupt branching lung morphogenesis resulting in pulmonary hypoplasia. (Source: Journal of Pediatric Surgery)

Evaluating mortality and disease severity in congenital diaphragmatic hernia using the McGoon and pulmonary artery indices

Journal of Pediatric Surgery — Sun, 01 Nov 2009 00:00:00 +0100

Conclusions: McGoon index (cutoff value, 1.31) and PAI (cutoff value, 90) are reliable indices for predicting mortality in CDH. Pulmonary artery index appears to be more useful than MGI for predicting disease severity among survivors. (Source: Journal of Pediatric Surgery)

Journal of Pediatric Surgery — Sun, 01 Nov 2009 00:00:00 +0100

The incidence of bloodstream infection (BSI) in extracorporeal life support (ECLS) is reported between 0.9 and 19.5%. In January 2006, the Extracorporeal Life Support Organization (ELSO) reported an overall incidence of 8.78% distributed as follows: respiratory: 6.5% (neonatal), 20.8% (pediatric); cardiac: 8.2% (neonatal) and 12.6% (pediatric). At British Columbia Children's Hospital (BCCH) daily surveillance blood cultures (BC) are performed and antibiotic prophylaxis is not routinely recommended. Positive BC (BC+) were reviewed, including resistance profiles, collection time of BC+, time to positivity and mortality. White blood cell count, absolute neutrophile count, immature/total ratio, platelet count, fibrinogen and lactate were analyzed 48, 24 and 0 h prior to BSI. A univariate linea...

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Microscopic magnetic resonance in congenital diaphragmatic hernia and associated malformations in rats

Pediatric Surgery International — Fri, 23 Oct 2009 18:53:21 +0100

Conclusions Microscopic magnetic resonance involves refined and expensive equipment but it provides a powerful research tool for the study of CDH and other malformations in rat fetuses. Further work on this area is warranted. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00383-009-2518-4Authors Montserrat Bret, Hospital Universitario La Paz Department of Radiology Madrid SpainAna Lourdes Luis, Hospital Universitario La Paz Department of Pediatric Surgery Paseo de la Castellana 261 28046 Madrid SpainEmilio Cuesta, Hospital Universitario La Paz Department of Radiology Madrid SpainFederica Pederiva, Hospital Universitario La Paz Department of Pediatric Surgery Paseo de la Castellana 261 28046 Madrid SpainRosa Aras, Hospital Universitario La Paz Departm...

Disturbance of parathyroid hormone-related protein signaling in the nitrofen-induced hypoplastic lung

Pediatric Surgery International — Fri, 23 Oct 2009 18:53:11 +0100

Conclusion Downregulation of PTHrP and PTHrP-R gene expression during late lung morphogenesis may cause pulmonary hypoplasia in the nitrofen CDH model, disrupting alveolar maturation and surfactant production by interfering with mesenchymal–epithelial interactions. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00383-009-2506-8Authors Takashi Doi, Our Lady’s Children’s Hospital The Children’s Research Centre Dublin 12 IrelandAušra Lukošiūtė, Our Lady’s Children’s Hospital The Children’s Research Centre Dublin 12 IrelandElke Ruttenstock, Our Lady’s Children’s Hospital The Children’s Research Centre Dublin 12 IrelandJens Dingemann, Our Lady’s Children’s Hospital The Children’s Research Centre Dublin 12 IrelandPrem Puri, Ou...

The evidence base for neonatal surgery

Early Human Development — Fri, 23 Oct 2009 15:19:14 +0100

Abstract: The practise of evidence based medicine means integrating the clinical expertise with the best available external clinical evidence from systematic research. There is a lack of supporting scientific evidence from rigorous trials in neonatal surgery. The indications for surgery and the type of operation performed in neonates are rarely supported by randomised controlled trials. As a consequence, the majority of the operations performed in neonates are supported by retrospective studies and surgeon preference.This review article is focussed on operations in neonates which are performed by general paediatric surgeons. Only a few randomised controlled trials have been performed in neonatal diseases such as congenital diaphragmatic hernia, necrotizing enterocolitis, pyloric stenosis a...

Upregulation of Endothelin Receptors A and B in the nitrofen induced hypoplastic lung occurs early in gestation

Pediatric Surgery International — Thu, 22 Oct 2009 18:56:03 +0100

Conclusion Altered expression of EDNRA and EDNRB is an early event in lung morphogenesis in the nitrofen model. We speculate that pulmonary arteries in CDH become excessively muscularised in early fetal life, becoming unable to adapt normally at birth. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00383-009-2514-8Authors Jens Dingemann, The Children’s Research Centre, Our Lady’s Children’s Hospital Dublin 12 IrelandTakashi Doi, The Children’s Research Centre, Our Lady’s Children’s Hospital Dublin 12 IrelandElke Ruttenstock, The Children’s Research Centre, Our Lady’s Children’s Hospital Dublin 12 IrelandPrem Puri, The Children’s Research Centre, Our Lady’s Children’s Hospital Dublin 12 Ireland Journal Pediatric Surgery ...

Downregulation of insulin-like growth factor binding protein 3 and 5 in nitrofen-induced pulmonary hypoplasia

Pediatric Surgery International — Wed, 21 Oct 2009 09:05:25 +0100

Conclusion Downregulation of IGFBP-3 and IGFBP-5 gene expression may cause pulmonary hypoplasia in the nitrofen-induced CDH model by interfering with retinoid signaling pathway. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00383-009-2509-5Authors Elke Ruttenstock, University College Dublin The Children’s Research Centre, Our Lady’s Children’s Hospital Dublin 12 IrelandTakashi Doi, University College Dublin The Children’s Research Centre, Our Lady’s Children’s Hospital Dublin 12 IrelandJens Dingemann, University College Dublin The Children’s Research Centre, Our Lady’s Children’s Hospital Dublin 12 IrelandPrem Puri, University College Dublin The Children’s Research Centre, Our Lady’s Children’s Hospital Dublin 12 Ireland ...

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Does Overnight Birth Influence Treatment or Outcome in Congenital Diaphragmatic Hernia?

American Journal of Perinatology — Tue, 13 Oct 2009 15:05:54 +0100

We examined the effect of overnight birth on treatment and outcome (including initial cardiorespiratory stabilization) in newborns with congenital diaphragmatic hernia (CDH). CDH births between May 2005 and May 2008 were abstracted from a national CDH database. Overnight birth was defined as occurring between 8 and 8 . Patient characteristics, treatment, and outcomes were compared between birth time groups, including the subset of infants in whom a prenatal diagnosis of CDH had been made. Of 132 cases evaluated, 106 (80%) survived. Forty-nine babies (37%) were born overnight. Eighty-five infants (64%) with a prenatal diagnosis were evenly distributed between the birth time cohorts. Survival to discharge, surgical management, duration of mechanical ventilation, and length of hospital stay w...

Prenatal retinoic acid up-regulates pulmonary gene expression of COUP-TFII, FOG2, and GATA4 in pulmonary hypoplasia

Journal of Pediatric Surgery — Wed, 30 Sep 2009 23:00:00 +0100

Conclusions: Up-regulation of pulmonary gene expression of COUP-TFII, FOG2, and GATA4 after prenatal treatment with retinoic acid in the nitrofen model of CDH suggests that RA may have a therapeutic potential in modulating lung growth. Furthermore, these results support the concept that these proteins work together to regulate downstream target genes that play an important role in the development of lung. (Source: Journal of Pediatric Surgery)

Congenital diaphragmatic hernia: outcome review of 2,173 surgical repairs in US infants

Pediatric Surgery International — Thu, 03 Sep 2009 06:24:53 +0100

This study, which represents the largest characterization of US infants who have undergone CDH repair using data from a nationally representative non-voluntary database, demonstrates that surgical repair is associated with significant mortality and morbidity. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00383-009-2473-0Authors Fizan Abdullah, Johns Hopkins University School of Medicine Division of Pediatric Surgery, Center for Pediatric Surgical Clinical Trials and Outcomes Research 600 North Wolfe Street, Harvey 319 Baltimore MD 21287-0005 USAYiyi Zhang, Johns Hopkins University Bloomberg School of Public Health Department of Epidemiology 2024 E. Monument Street, Suite 2-516 Baltimore MD 21205-2223 USAChristopher Sciortino, Johns Hopkins University School of Me...

Congenital diaphragmatic hernia: neonatal outcomes following referral to a paediatric surgical centre.

Ir Med J — Tue, 01 Sep 2009 00:00:00 +0100

Authors: Chukwu J, Iro C, Donoghue V, McCallion N, Murphy JF, Quinn F, Healy M, Molloy EJ Congenital diaphragmatic hernia (CDH) is a rare malformation observed in approximately 1 in 3000 live births. Estimates of postnatal survival range from 50 to 70% despite advances in neonatal care. Antenatal diagnosis is associated with termination of pregnancy in 25-50% pregnancy internationally which may not be reflective of the Irish population. We aimed to evaluate the mortality of infants with CDH who survived to admission in a tertiary referral paediatric hospital between 1996 and 2007. The Hospital In-Patient Enquiry system was used to determine the number of neonatal referrals for CDH to OLHSC between 1996 and 2007. Mortality, sex distribution, length of patient stay and the number of case...

A prospective comparative evaluation of persistent respiratory morbidity in esophageal atresia and congenital diaphragmatic hernia survivors

Journal of Pediatric Surgery — Mon, 31 Aug 2009 23:00:00 +0100

Conclusions: Esophageal atresia and CDH are associated with equal risk of long-term respiratory morbidity, growth impairment, and disturbed maximal exercise performance. Prospective follow-up of EA patients aimed at identifying respiratory problems other than tracheomalacia should be an integral part of interdisciplinary follow-up programs. (Source: Journal of Pediatric Surgery)

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Outcome analysis of neonates with congenital diaphragmatic hernia treated with venovenous vs venoarterial extracorporeal membrane oxygenation

Journal of Pediatric Surgery — Mon, 31 Aug 2009 23:00:00 +0100

Conclusion: The short-term outcomes of VV and VA are comparable. Patients with CDH who fail VV may be predisposed to a worse outcome. Nevertheless, VV offers equal benefit to patients with CDH requiring ECMO while preserving the native carotid. (Source: Journal of Pediatric Surgery)

Beyond feasibility: a comparison of newborns undergoing thoracoscopic and open repair of congenital diaphragmatic hernias

Journal of Pediatric Surgery — Mon, 31 Aug 2009 23:00:00 +0100

Conclusions: Successful thoracoscopic CDH repair can be expected in newborns, which has limited respiratory compromise. Thoracoscopic CDH repair is associated with lower morbidity and quicker recovery than traditional open repair and without increased risk of recurrence or complications. (Source: Journal of Pediatric Surgery)

Thoracic kidney associated with congenital diaphragmatic hernia

Congenital Anomalies — Tue, 25 Aug 2009 23:00:00 +0100

We report three cases of ectopic thoracic (or superior ectopic) kidney; one in a neonate and two in 6-month-old children, associated with congenital diaphragmatic hernia. In all cases the diagnosis was made during surgery and confirmed by intravenous pyelography, sonography and magnetic resonance imaging in the postoperative period. Because of the rarity of this condition we report these cases together with a wide review of the published reports. (Source: Congenital Anomalies)

Pneumomediastinum and Tension Pneumopericardium After Congenital Diaphragmatic Hernia Repair: Presentation and Transcatheter Drainage

Pediatric Cardiology — Tue, 25 Aug 2009 06:45:37 +0100

Content Type Journal ArticleCategory Images in Pediatric CardiologyDOI 10.1007/s00246-009-9519-xAuthors James S. Killinger, Children’s Hospital at Montefiore, Montefiore Medical Center and Albert Einstein College of Medicine Department of Pediatrics 3415 Bainbridge Avenue, Rosenthal 1 Bronx NY 10467-2183 USASara L. P. Ross, Children’s Hospital at Montefiore, Montefiore Medical Center and Albert Einstein College of Medicine Department of Pediatrics 3415 Bainbridge Avenue, Rosenthal 1 Bronx NY 10467-2183 USARobert H. Pass, Children’s Hospital at Montefiore, Montefiore Medical Center and Albert Einstein College of Medicine Department of Pediatrics 3415 Bainbridge Avenue, Rosenthal 1 Bronx NY 10467-2183 USA Journal Pediatric CardiologyOnline ISSN 1432-1971Print ISSN 0172-0643 ...

Sonic hedgehog gene expression in nitrofen induced hypoplastic lungs in mice

Pediatric Surgery International — Wed, 19 Aug 2009 08:28:17 +0100

Conclusion Although altered Shh expression in the hypoplastic lung has been reported in late gestation, the present study did not reveal any significant alterations in pulmonary Shh spatial transcript distribution or gene expression level during the early gestation in nitrofen CDH model. It would be of great interest in future studies to use OPT approach to investigate pulmonary expression of Shh and other regulatory genes both during early and late stages of lung development in order to provide new insights into the pathogenesis of pulmonary hypoplasia. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00383-009-2452-5Authors Hideaki Sato, Our Lady’s Children’s Hospital Children’s Research Centre Crumlin Dublin IrelandPaula Murphy, University ...

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What Are the Complications of Cardiothoracic Surgery?

PediatricEducation.org — Mon, 17 Aug 2009 00:01:25 +0100

Discussion Congenital diaphragmatic hernia (CDH) occurs in 1 / 2000-3000 live births. Its overall mortality has been hard to determine as many infants die in-utero or just after birth before transfer for surgical care. One study found that ~61% of fetuses with CDH are live born. Many of these fetuses had other congenital anomalies. Mortality after live birth is ~ 40-62%. There are 3 major types of CDH: Bochdalek hernia which occurs posterolaterally Morgagni hernia which occurs anteriorly Hiatus hernia Left sided Bochdalek hernias are the most common (85%). Treatment currently includes fetal surgical repair, post-natal surgical repair and critical care. Learning Point Cardiothoracic surgical repairs are critical for treatment of CDH and other congenital heart disease or congenital malf...

Can we improve outcome of congenital diaphragmatic hernia?

Pediatric Surgery International — Sun, 09 Aug 2009 11:04:06 +0100

Abstract This review gives an overview of the disease spectrum of congenital diaphragmatic hernia (CDH). Etiological factors, prenatal predictors of survival, new treatment strategies and long-term morbidity are described. Early recognition of problems and improvement of treatment strategies in CDH patients may increase survival and prevent secondary morbidity. Multidisciplinary healthcare is necessary to improve healthcare for CDH patients. Absence of international therapy guidelines, lack of evidence of many therapeutic modalities and the relative low number of CDH patients calls for cooperation between centers with an expertise in the treatment of CDH patients. The international CDH Euro-Consortium is an example of such a collaborative network, which enhances exchange o...

Expression of chloride channels in trachea-occluded hyperplastic lungs and nitrofen-induced hypoplastic lungs in rats

Pediatric Surgery International — Mon, 03 Aug 2009 20:42:46 +0100

Conclusion We show that the developmental changes in ClC-2 and ClC-3 protein expression are negatively affected in hypoplastic CDH lungs. Lung hyperplasia created by TO up-regulates the expression of ClC-2. ClC-2 is therefore an interesting potential target in the development of novel, non-invasive, therapies for CDH treatment. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00383-009-2423-xAuthors Andreas Ringman Uggla, Karolinska Institutet Research Laboratory Q2:09, Department of Woman and Child Health, Nordic Centre of Excellence for Research in Water Imbalance Related Disorders (WIRED), Astrid Lindgren Children’s Hospital, Karolinska University Hospital 171 76 Stockholm SwedenMarina Zelenina, Karolinska Institutet Research Laboratory Q2:09, De...

Delayed presentation of congenital diaphragmatic hernia with intrathoracic gastric volvulus.

World Journal of Pediatrics : WJP — Fri, 31 Jul 2009 23:00:00 +0100

CONCLUSIONS: GV is a clinical emergency which can be life-threatening for children. Upper gastrointestinal study and CT scan with contrast meal are helpful in the diagnosis of the lesion. We emphasize prompt surgical therapy to avoid gastric necrosis. PMID: 19693469 [PubMed - as supplied by publisher] (Source: World Journal of Pediatrics : WJP)

Effect of prenatal tetrandrine administration on transforming growth factor-β1 level in the lung of nitrofen-induced congenital diaphragmatic hernia rat model

Journal of Pediatric Surgery — Tue, 28 Jul 2009 11:48:04 +0100

Conclusion: Nitrofen can interfere with lung development early in the fetal rat development before and separate from diaphragm development, and increased expression of TGF-β1 in the lung of CDH rat model may suppress lung growth and development. Prenatal treatment with Tet can improve the growth of the lung of the nitrofen-induced CDH fetuses and its mechanism seems to be involved in downregulating the expression of TGF-β1. It is a likely new approach to treat CDH and its coexistent lung hypoplasia by maternal Tet administration. (Source: Journal of Pediatric Surgery)

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Congenital diaphragmatic hernia with a pure duplication of chromosome 1q: report of the first surviving case

Pediatric Surgery International — Sat, 25 Jul 2009 04:20:51 +0100

We present the first surviving case of CDH with a duplication of 1q12–q23, who had arthrogryposis multiplex congenita and hypertrophic cardiomyopathy. CDH patients with a proximal duplication of chromosome 1q may have a chance for survival, and CDH with a duplication of chromosome 1q is not necessarily a lethal association. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s00383-009-2421-zAuthors Kohei Otake, Mie University Graduate School of Medicine Department of Gastrointestinal and Pediatric Surgery Edobashi 2-174 Tsu Mie 514-8507 JapanKeiichi Uchida, Mie University Graduate School of Medicine Department of Gastrointestinal and Pediatric Surgery Edobashi 2-174 Tsu Mie 514-8507 JapanMikihiro Inoue, Mie University Graduate School of Medicine Department of Gastrointes...

Congenital diaphragmatic hernia: review of the literature in reflection of unresolved dilemmas

Acta Paediatrica — Sun, 19 Jul 2009 23:00:00 +0100

Conclusion: The high survival of 'selected cases' that are live births and benefit from optimal care will be difficult to improve by antenatal interventions. The multidisciplinary approach to basic research and randomized clinical trials will further define the best approach to the foetus and neonate with CDH. (Source: Acta Paediatrica)

Thoracoscopic Repair of Congenital Diaphragmatic Hernia in Neonates: Lessons Learned

Journal of Laparoendoscopic — Sun, 12 Jul 2009 18:32:36 +0100

Journal of Laparoendoscopic & Advanced Surgical Techniques , Vol. 0, No. 0. (Source: Journal of Laparoendoscopic)

Decreased surfactant phosphatidylcholine synthesis in neonates with congenital diaphragmatic hernia during extracorporeal membrane oxygenation

Intensive Care Medicine — Tue, 07 Jul 2009 15:22:26 +0100

Conclusion These results show that CDH patients who require ECMO have a decreased surfactant PC synthesis, which may be part of the pathogenesis of severe pulmonary insufficiency and has a negative impact on weaning from ECMO. Content Type Journal ArticleCategory Pediatric OriginalDOI 10.1007/s00134-009-1564-7Authors Daphne J. Janssen, Intensive Care Erasmus MC-Sophia Children’s Hospital Department of Pediatrics and Pediatric Surgery P.O. Box 2060 3000 CB Rotterdam The NetherlandsLuc J. Zimmermann, University Hospital Maastricht Division of Neonatology Maastricht The NetherlandsPaola Cogo, University of Padova Department of Pediatrics Padua ItalyAaron Hamvas, Washington University/St. Louis Children’s Hospital Department of Pediatrics St. Louis USAKajsa Bohlin, Was...

Anterior fundoplication at the time of congenital diaphragmatic hernia repair

Pediatric Surgery International — Mon, 06 Jul 2009 20:15:04 +0100

Conclusion Anatomic predictors of severe GER can be efficiently countered at the time of CDH repair. A modified fundoplication should be considered in the operative management of high-risk infants. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00383-009-2411-1Authors Yigit S. Guner, University of California Davis Medical Center Department of General Surgery Sacramento CA 95817 USASteven Elliott, University of California Davis Medical Center Department of General Surgery Sacramento CA 95817 USAClifford C. Marr, University of California Davis Medical Center Department of General Surgery Sacramento CA 95817 USAStephen K. Greenholz, University of California Davis Medical Center Department of General Surgery Sacramento CA 95817 USA Journal Pediatr...

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Prenatal findings of concomitant duodenal and esophageal atresia without tracheoesophageal fistula (Gross type A)

Journal of Clinical Ultrasound — Sat, 04 Jul 2009 23:00:00 +0100

We describe prenatal findings of one such case. Sonographic examination of a 26-week fetus showed a double cystic structure and an intrathoracic cyst. MRI and ultrasound at 26 weeks and 2 days' gestation showed shrinkage of the stomach and duodenum, massive ascites, and the presence of dilated pouch-like structure in the thoracic inlet level, consistent with an upper pouch sign. Polyhydramnios was detected at 30 weeks' gestation. Prenatal diagnosis was concomitant DA and an intrathoracic anomaly such as congenital hiatal hernia, diaphragmatic hernia, esophageal duplication or EA. A boy was delivered at 38 weeks' gestation. Physical examination showed a markedly distended abdomen and imperforate anus. Emergency surgery revealed existing DA and EA without TEF (Gross type A). © 2009 Wiley Pe...

Impaired somatic growth and delayed lung development in infants with congenital diaphragmatic hernia—evidence from a 10-year, single center prospective follow-up study

Journal of Pediatric Surgery — Tue, 30 Jun 2009 23:00:00 +0100

Conclusion: Despite apparently well-inflated lungs after surgery, evidence of early and significantly reduced weight gain and impaired lung function in CHD patients should prompt careful dietary monitoring and regular lung function testing. (Source: Journal of Pediatric Surgery)

Factors associated with survival in infants with congenital diaphragmatic hernia requiring extracorporeal membrane oxygenation: a report from the Congenital Diaphragmatic Hernia Study Group

Journal of Pediatric Surgery — Tue, 30 Jun 2009 23:00:00 +0100

Conclusion: Our model identifies a group of pre-surgical and postsurgical parameters that predict survival rate in patients with CDH on ECMO support. This model was derived from the retrospective data from a large database and will need to be prospectively tested. (Source: Journal of Pediatric Surgery)

Interdisciplinary structural follow-up of surgical newborns: a prospective evaluation

Journal of Pediatric Surgery — Tue, 30 Jun 2009 23:00:00 +0100

Conclusions: The CA survivors show impaired growth and psychomotor developmental delay up to age 2 years. This warrants specific follow-up programs and infrastructure for these patients. (Source: Journal of Pediatric Surgery)

Journal of Pediatric Surgery — Tue, 30 Jun 2009 23:00:00 +0100

Prostaglandin-E1 (PGE1) is used at most centers for treating pulmonary hypertension (PH) in congenital diaphragmatic hernia (CDH) because it has been regarded as effective. The aim of this study was to investigate the role of PGE1 for treating PH in CDH. Forty-nine CDH cases were reviewed with echocardiography-proven PH. PH was treated with PGE1 and nitric oxide (NO) and high-frequency oscillatory ventilation (HFOV) from 1997 to 2001 (PG + NO; n = 19) and with NO and HFOV from 2002 to 2007 (NO; n = 30). Subject demographics, severity of PH, and presence of other anomalies were not significantly different between the 2 groups. In the PG + NO group, 12/19 (63.2%) survived (PG + NO-s) and 7/19 (36.8%) died (PG + NO-d). In the NO group, 21/30 (70.0%) survived (NO-s) and 9/30 (30.0%) died (NO-d...

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Wandering Spleen Causing Intestinal Obstruction after Repair of Congenital Diaphragmatic Hernia

European Journal of Pediatric Surgery — Thu, 25 Jun 2009 08:25:32 +0100

Eur J Pediatr SurgDOI: 10.1055/s-0029-1220708© Georg Thieme Verlag KG Stuttgart · New YorkGet connected:Table of contents | Full text (Source: European Journal of Pediatric Surgery)

The impact of iatrogenic gastroschisis on pulmonary maturation in the fetal rabbit models of congenital diaphragmatic hernia

Pediatric Surgery International — Sat, 13 Jun 2009 08:38:14 +0100

Conclusions In the fetal rabbit models of CDH, pulmonary hypoplasia is the most significant pathological feature. Iatrogenic gastroschisis does not improve pulmonary maturation due to the active growth of the liver that herniates into the thoracic cavity. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00383-009-2384-0Authors Gong Chen, FUDAN University Shanghai ChinaShan Zheng, FUDAN University Shanghai ChinaXian Min Xiao, FUDAN University Shanghai ChinaYi Luo, FUDAN University Shanghai China Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358 (Source: Pediatric Surgery International)

The Myenteric Plexus of the Esophagus is Abnormal in an Experimental Congenital Diaphragmatic Hernia Model

European Journal of Pediatric Surgery — Mon, 08 Jun 2009 04:01:53 +0100

Eur J Pediatr Surg 2009; 19: 163-167DOI: 10.1055/s-0029-1202854Abstract Infants surviving congenital diaphragmatic hernia (CDH) suffer from anatomical and functional esophageal abnormalities. Previous work in the nitrofen animal model of CDH demonstrated malformations in neural crest-derived structures, including the vagus and recurrent laryngeal nerves. The aim of the present study was to assess whether the esophageal myenteric plexus is abnormal in rats with CDH.[...]© Georg Thieme Verlag KG Stuttgart · New YorkGet connected:Table of contents | Abstract | Full text (Source: European Journal of Pediatric Surgery)

Tracheal innervation is abnormal in rats with experimental congenital diaphragmatic hernia

Journal of Pediatric Surgery — Sun, 31 May 2009 23:00:00 +0100

Conclusions: Decreased density of neural structures and size of intramural ganglia, reduced expression of neural tissue and PGP 9.5 protein, and increased levels of PGP 9.5 mRNA reveal deficient tracheal innervation in rats with CDH. If similar anomalies exist in the human condition, they could contribute to explaining the pathogenesis of lung hypoplasia and bronchopulmonary sequelae. (Source: Journal of Pediatric Surgery)

Congenital diaphragmatic hernia requiring extracorporeal membrane oxygenation: does timing of repair matter?

Journal of Pediatric Surgery — Sun, 31 May 2009 23:00:00 +0100

Conclusion: These data suggest that CDH repair after ECMO therapy is associated with improved survival compared to repair on ECMO, despite controlling for factors associated with the severity of CDH. (Source: Journal of Pediatric Surgery)

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Multivariate model for predicting recurrence in congenital diaphragmatic hernia

Journal of Pediatric Surgery — Sun, 31 May 2009 23:00:00 +0100

Conclusion: Neonates at risk for CDH recurrence are better identified by postnatal treatment variables than by prenatal patient factors. Although age at repair and diaphragm patch use are greater in recurrence patients, the only factors to independently predict recurrence were postoperative LOS and abdominal wall patch use. These data can help optimize follow-up regimens. (Source: Journal of Pediatric Surgery)

Chylothorax after congenital diaphragmatic hernia repair

Journal of Pediatric Surgery — Sun, 31 May 2009 23:00:00 +0100

Conclusions: The incidence of chylothorax at our institution was relatively low. Patch repair was associated with the formation of chylothorax. Morbidity was substantial, but survival was not significantly affected. Total parenteral nutrition and thoracostomy were appropriate initial treatments. Octreotide was not an effective adjunct. Refractory cases were successfully treated with pleurectomy. (Source: Journal of Pediatric Surgery)

Influence of extracorporeal membrane oxygenation on subsequent surgeries after congenital diaphragmatic hernia repair

Journal of Pediatric Surgery — Sun, 31 May 2009 23:00:00 +0100

Conclusion: In this series, ECMO survivors are at a high risk for requiring subsequent surgeries compared to the total CDH group. This information can be used as an education tool for referring physicians and parents as they care for this group of children. (Source: Journal of Pediatric Surgery)

Persistent nonhealing skin fistulous tract after congenital diaphragmatic hernia repair.

Canadian Journal of Surgery — Sun, 31 May 2009 23:00:00 +0100

Authors: Vasquez JC, Montesinos E, DeLaRosa J, Leon JJ PMID: 19503656 [PubMed - indexed for MEDLINE] (Source: Canadian Journal of Surgery)

Thoracoscopic Repair in the Neonatal Intensive Care Unit for Congenital Diaphragmatic Hernia During High-Frequency Oscillatory Ventilation

Journal of Laparoendoscopic — Mon, 11 May 2009 16:03:54 +0100

Journal of Laparoendoscopic & Advanced Surgical Techniques , Vol. 0, No. 0. (Source: Journal of Laparoendoscopic)

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Improvement in the outcome of patients with antenatally diagnosed congenital diaphragmatic hernia using gentle ventilation and circulatory stabilization

Pediatric Surgery International — Thu, 07 May 2009 05:53:24 +0100

Conclusion Our strategy of using GV ± CS might thus be considered to be more effective than that using FS in the treatment of AD-CDH patients. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00383-009-2370-6Authors Kouji Masumoto, Graduate School of Medical Sciences, Kyushu University Department of Pediatric Surgery, Reproductive and Developmental Medicine 3-1-1, Maidashi, Higashi-ku Fukuoka 812-8582 JapanRisa Teshiba, Graduate School of Medical Sciences, Kyushu University Department of Pediatric Surgery, Reproductive and Developmental Medicine 3-1-1, Maidashi, Higashi-ku Fukuoka 812-8582 JapanGenshiro Esumi, Graduate School of Medical Sciences, Kyushu University Department of Pediatric Surgery, Reproductive and Developmental Medicine 3-1-1...

Caecal perforation with faecal peritonitis - unusual presentation of Bochdalek hernia in an adult: a case report and review of literature

World Journal of Emergency Surgery — Wed, 06 May 2009 04:00:00 +0100

The improper fusion of the postero-lateral foramen of the diaphragm was first described by Bochdalek in 1848. The incidence of congenital diaphragmatic hernia varies from1:2000 to 1:5000 live births and Bochdalek hernias (BH) account for 75 to 85 % of these. Although it is a well-known entity in neonates, it is occasionally discovered incidentally in adult patients. Until now, a total of around 100 cases of occult asymptomatic Bochdalek hernia have been reported. The symptomatic cases are encountered more rarely. Colon necrosis among the symptomatic cases was reported in some reports. We discuss the present case since we believe it to be, to the best of our knowledge, the first case of a Bochdalek hernia in an adult presenting with caecal perforation and faecal peritonitis and review the p...

Effect of hospital case volume on outcome in congenital diaphragmatic hernia: the experience of the Canadian Pediatric Surgery Network

Journal of Pediatric Surgery — Fri, 01 May 2009 04:00:00 +0100

Conclusion: Hospital case volume may be partially responsible for mortality rate variation in CDH. This result requires careful analysis, as case volume may merely be a surrogate for other predictive variables. (Source: Journal of Pediatric Surgery)

Absolute vs relative improvements in congenital diaphragmatic hernia survival: what happened to “hidden mortality”

Journal of Pediatric Surgery — Fri, 01 May 2009 04:00:00 +0100

Conclusion: A hidden mortality exists for institutionally reported CDH survival rates. Careful interpretation of research findings and more comprehensive population-based tools are needed for reliable counseling and evaluation of current and future treatments. (Source: Journal of Pediatric Surgery)

Right-sided congenital diaphragmatic hernia: high utilization of extracorporeal membrane oxygenation and high survival

Journal of Pediatric Surgery — Fri, 01 May 2009 04:00:00 +0100

Conclusions: Our data suggest that patients with R-CDH have high ECMO utilization and may experience greater relative benefit from ECMO as evidenced by their higher-than-expected overall survival. Extracorporeal membrane oxygenation may be found to have a distinctive role in managing R-CDH. More high-powered series are needed to elucidate differences between R-CDH and left-sided CDH that may dictate alternate forms of management. (Source: Journal of Pediatric Surgery)

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Journal of Pediatric Surgery — Fri, 01 May 2009 04:00:00 +0100

The aim of this study was to describe the long-term functional impact of congenital diaphragmatic hernia (CDH) repair on survivors of a cohort of newborns. The medical charts of 26 CDH survivors were analyzed. The median age at follow-up was 51 (14-141) months. One patient (4%) had died by the age of 3 months. Thirteen patients (50%) presented with at least one sequelae, 6 (23%) presented with 2 or more. Gastrointestinal problems were the most prevalent, with 6 children (23%) below the fifth percentile for weight and 3 (12%) with gastroesophageal reflux. Respiratory morbidity was present in 4 patients (15%). Four (15%) exhibited neurological problems. No case of sensorineural hearing loss was found. Other findings included musculoskeletal anomalies (12%) recurrence of CDH (8%) and patch re...

Late presentation of diaphragmatic hernia in a Pacific Island pediatric population.

Hawaii Medical Journal — Tue, 31 Mar 2009 23:00:00 +0100

CONCLUSION: CDH, especially L-pCDH occurs with increased frequency in the USAPIs. The Web-based-store-and-forward telemedicine PIHCP allows for remote diagnosis. Patients so identified are transported to TAMC for definitive treatment. These patients provide excellent GME to our residents-in-training. Following surgical correction these patients are restored to health to return to their homes to mature and become contributing members of society. PMID: 19441615 [PubMed - indexed for MEDLINE] (Source: Hawaii Medical Journal)

Patent ductus arteriosus flow patterns in the treatment of congenital diaphragmatic hernia

Pediatrics International — Mon, 30 Mar 2009 23:00:00 +0100

Conclusions: PDAFP was a reliable marker of PPHN on a high-frequency oscillatory ventilator to determine the optimal time for the operation for CDH. The optimal time for operation is supposed to be the time when PDAFP become left to right shunt dominant. (Source: Pediatrics International)

[Unilateral pulmonary agenesis, aplasia and dysplasia.]

Zeitschrift fur Geburtshilfe und Neonatologie — Sun, 29 Mar 2009 02:05:45 +0100

Authors: Dembinski J, Kroll M, Lewin M, Winkler P Unilateral pulmonary anomalies are rare events of unknown etiology and large clinical variability. Neonatal history does not allow for a reliable prognosis. Interdisciplinary mangament includes prenatal diagnostics and obstetrics, genetics, neonatology, pediatric cardiology and surgery as well as pediatric orthopedics. Neonatal history and long-term follow-up in three patients are presented here including a discussion of prenatal diagnostics and the embryo-genetic basics of lung development. In three term neonates the diagnoses of unilateral pulmonary agenesis, aplasia and dysplasia, respectively, were based on angiography, MRI and bronchoscopy. Neonatal presentation and long-term consequences were studied in the context of the current ...

Congenital Diaphragmatic Hernia: Comparison of Animal Models and Relevance to the Human Situation.

Neonatology — Fri, 27 Mar 2009 04:00:00 +0100

Authors: van Loenhout RB, Tibboel D, Post M, Keijzer R Congenital diaphragmatic hernia (CDH) occurs in 1 in 3,000 newborns. Mortality and morbidity are due to the amount of pulmonary hypoplasia (PH), the response on artificial ventilation and the presence of therapy-resistant pulmonary hypertension. The pathogenesis and etiology of CDH and its associated anomalies are still largely unknown despite all research efforts over the past years. Several animal models have been proposed to study CDH. In this review we compare surgical, pharmacological and transgenic models, and discuss their strengths and limitations to study PH. PMID: 19325248 [PubMed - as supplied by publisher] (Source: Neonatology)

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Laparoscopic repair of adult diaphragmatic hernias and eventration with primary sutured closure and prosthetic reinforcement: a retrospective study

Surgical Endoscopy — Sat, 14 Mar 2009 13:41:15 +0100

Conclusion The controversies involved are the surgical approach, management of the hernial sac, whether or not to suture the defect, and choice of prosthesis. Although laparoscopic and thoracoscopic approaches are comparable, the laparoscopic approach seems to have certain distinct advantages. The authors prefer not to excise the hernial sac and favor suturing the defects before mesh reinforcement. Regarding the type of mesh used, composite, expanded polytetrafluoroethylene (ePTFE), or polypropylene are the available options. Laparoscopic repair is feasible, effective, and reliable. It could become the gold standard in the near future. Content Type Journal ArticleDOI 10.1007/s00464-008-0294-1Authors Chinnusamy Palanivelu, GEM Hospital and Postgraduate Institute 45-...

Neonatal minimally invasive surgery for congenital diaphragmatic hernias: a multicenter study using thoracoscopy or laparoscopy

Surgical Endoscopy — Thu, 05 Mar 2009 14:42:23 +0100

Conclusions In the neonatal period, CDH can be safely closed using MIS procedures. The overall success rate in this study was 67%. The indication for MIS is not related to weeks of gestational age, to weight at birth (if >2,600 g), or to the extent of the immediate neonatal care. Patients with no associated anomaly who are hemodynamically stabilized can benefit from MIS procedures. Reduction of the herniated organs is easier using thoracoscopy. Right CDH, liver lobe herniation, and the need for a patch closure are the most frequent reasons for conversion. Content Type Journal ArticleCategory New TechnologyDOI 10.1007/s00464-009-0334-5Authors Cindy Gomes Ferreira, University Hospital Departement of Pediatric Surgery Pôle Mère-Enfant – Hôpital de Hau...

Abnormal intrinsic esophageal innervation in congenital diaphragmatic hernia: a likely cause of motor dysfunction

Journal of Pediatric Surgery — Sun, 01 Mar 2009 05:00:00 +0100

Conclusion: Intrinsic innervation of the lower esophagus in CDH is abnormal in terms of decreased density of neural structures in the intermuscular plexus. These neural crest-derived anomalies could explain in part the esophageal dysfunction in survivors of CDH. (Source: Journal of Pediatric Surgery)

Journal of Pediatric Surgery — Sun, 01 Mar 2009 05:00:00 +0100

The authors present a retrospective study in children with congenital diaphragmatic hernia (congenital diaphragmatic hernia) treated from 1997 to 2006. ECMO was not used. There were 61 newborns (30 male/31 female), with a birth weight of 2800 g (880-3770 g) and a gestational age of 38 weeks (28-41 weeks). Forty-two (69%) had a prenatal diagnosis of CDH. There were 2 (3%) chromosomal anomalies, 3 (5%) associated malformations and 1 (2%) non-immune hydrops fetalis. The CDH was left-sided in 55 (90%) of cases. Corrective surgery was carried put in 43 (70%) patients. New treatment protocols were used: high-frequency oscillatory ventilation (HFOV) in 8 patients (13%), inhaled nitric oxide (INO) in 8 patients (13%), and administration of sildenafil in 4 (7%). It was found that systemic arterial ...

Journal of Pediatric Surgery — Sun, 01 Mar 2009 05:00:00 +0100

Congenital anterior diaphragmatic hernias (ADH) account for 2%-6% of diaphragmatic defects, whereas acquired ADHs are rare. These hernias are most often the result of blunt or penetrating trauma. This is the first report of a iatrogenic ADH in childhood. Two children with asymptomatic iatrogenic ADH were diagnosed at 6 and 12 months of age, respectively. Both had undergone previous cardiac surgery, requiring pericardial drainage. The ADH was seen on an incidental chest x-ray in one patient, and during a laparoscopic-assisted gastrostomy in the other. Both ADHs were successfully repaired laparoscopically. Subxiphoid pericardial drains may result in iatrogenic ADH. A high index of suspicion after cardiac surgery is necessary to avoid this potentially serious complication. (Source: Journal of...

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Maternal-fetal surgery: where are we and how did we get here?

Obstetrics and Gynecology — Sun, 01 Mar 2009 05:00:00 +0100

Authors: Chescheir NC Using the criteria proposed in 1982 to justify consideration of in utero surgical treatment of fetal disorders, the development of maternal-fetal treatment is described, and an assessment of current status is provided. Significant issues remain, and many questions are unanswered. By using three different disorders, congenital diaphragmatic hernia, open spina bifida, and twin-to-twin transfusion, the complexity and sophistication of the field are explored, as well as the existing gaps in understanding. PMID: 19300340 [PubMed - in process] (Source: Obstetrics and Gynecology)

Minimally Invasive Repair of a Congenital Right-sided Diaphragmatic Hernia in an Adult.

Surgical Laparoscopy, Endoscopy & Percutaneous Techniques — Fri, 20 Feb 2009 18:20:17 +0100

Page: e5DOI: 10.1097/SLE.0b013e318195c42eAuthors: Fraser, Jason D. MD; Craft, Randall O. MD; Harold, Kristi L. MD; Jaroszewski, Dawn E. MD (Source: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques)

Temporary Banding of a Lower Tracheoesophageal Fistula in an Infant with Left Congenital Diaphragmatic Hernia and Esophageal Atresia

European Journal of Pediatric Surgery — Thu, 19 Feb 2009 03:02:38 +0100

Eur J Pediatr SurgDOI: 10.1055/s-2008-1038960© Georg Thieme Verlag KG Stuttgart · New YorkGet connected:Table of contents | Full text (Source: European Journal of Pediatric Surgery)

Intrathoracic Kidney Associated with Congenital Diaphragmatic Hernia – A Causal Relationship?

European Journal of Pediatric Surgery — Sun, 08 Feb 2009 19:49:48 +0100

Eur J Pediatr SurgDOI: 10.1055/s-2008-1039005© Georg Thieme Verlag KG Stuttgart · New YorkGet connected:Table of contents | Full text (Source: European Journal of Pediatric Surgery)

A pediatric surgeon retools in genetics and genomics to study congenital diaphragmatic hernia

Journal of Pediatric Surgery — Sun, 01 Feb 2009 05:00:00 +0100

Abstract: Prof Donahoe outlines her career-long interest in congenital diaphragmatic hernia and how this has led to her current investigations into its etiology and possible treatment using gene probes. (Source: Journal of Pediatric Surgery)

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Congenital diaphragmatic hernia: prognostic indices in the fetal endoluminal tracheal occlusion era

Journal of Pediatric Surgery — Sun, 01 Feb 2009 05:00:00 +0100

Conclusion: Best oxygenation index on day 1 is the best early postnatal predictor of survival. The more recently evaluated prenatal index, LHR, has an observable relationship with BOI (d1) when it is used as a surrogate marker of outcome. (Source: Journal of Pediatric Surgery)

The hidden mortality of congenital diaphragmatic hernia: a 20-year review

Journal of Pediatric Surgery — Sun, 01 Feb 2009 05:00:00 +0100

Conclusions: The true incidence of CDH is considerably higher than that seen in neonatal surgical practice. The decline in number of PMs in our region will exacerbate the underestimation of the true incidence. There is a higher incidence of right-sided/bilateral hernias and more than one major anomaly in those who die in utero. (Source: Journal of Pediatric Surgery)

Up-regulation of COUP-TFII gene expression in the nitrofen-induced hypoplastic lung

Journal of Pediatric Surgery — Sun, 01 Feb 2009 05:00:00 +0100

Conclusions: Our results provide evidence for the first time that the pulmonary gene expression of COUP-TFII is up-regulated in the early stages of lung development in the nitrofen-induced hypoplastic lung. We speculate that up-regulation of COUP-TFII gene expression during the stage of branching lung morphogenesis may cause pulmonary hypoplasia by repressing RSP. (Source: Journal of Pediatric Surgery)

Sex reversal and hypoplastic left heart syndrome

The Journal of Thoracic and Cardiovascular Surgery — Tue, 27 Jan 2009 00:00:00 +0100

We report the case of a patient with sex reversal and hypoplastic left heart syndrome without congenital diaphragmatic hernia who has survived to Fontan completion and is doing well. (Source: The Journal of Thoracic and Cardiovascular Surgery)

Timing of Delivery and Survival Rates for Infants With Prenatal Diagnoses of Congenital Diaphragmatic Hernia

PEDIATRICS — Mon, 26 Jan 2009 05:00:00 +0100

CONCLUSIONS. The timing of delivery is an independent, potentially important factor in the consideration of elective delivery for infants diagnosed prenatally as having congenital diaphragmatic hernias. Among fetuses with prenatally diagnosed congenital diaphragmatic hernias and without major associated anomalies, early term delivery may confer advantage. (Source: PEDIATRICS)

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Congenital malformation of the diaphragm and left colon: Strangulated Bochdalek hernia in an adult

Surgical Practice — Fri, 23 Jan 2009 05:00:00 +0100

An unusual adult case of non-traumatic diaphragmatic hernia through the foramen of Bochdalek is reported. Congenital abnormality of the diaphragm remained undetected until the emergency presentation in the sixth decade of life. It was associated with absence of the phrenicocolic ligament and extreme mobility of the left colon, which allowed its herniation into the thorax. The association of these embryological abnormalities of the diaphragm and the hindgut has not been previously described. (Source: Surgical Practice)

Feasibility of complex minimally invasive surgery in neonates

Pediatric Surgery International — Wed, 21 Jan 2009 23:22:48 +0100

Abstract The aim of this study was to assess the feasibility of complex minimally invasive surgery in neonates (and infants <5 kg). A systematic search of databases was performed. Inguinal herniotomy and pyloromyotomy were specifically excluded. Various operations were assessed for operative times, conversion rates, complications and centres performing the procedures. From 479 abstracts, 50 papers were identified describing 1,215 patients. Common operations performed were fundoplication (n = 473), operations for ovarian pathology (n = 151) and oesophageal atresia repair (n = 123). Other not-so-common operations included Kasai procedure (n = 61), Ladd’s procedure (n = 55), bowel atresia surgery (n = 45) and ...

Bloodstream infections in pediatric ECLS: usefulness of daily blood culture monitoring and predictive value of biological markers. The British Columbia experience

Pediatric Surgery International — Fri, 16 Jan 2009 12:46:48 +0100

Conclusion Compared with ELSO, the studied BSI incidence was higher with a comparable mortality. We speculate that our BSI rate is explained by underreporting of “contaminants” in the literature, the use of broad-spectrum antibiotic prophylaxis and a higher yield with daily monitoring BC. We support daily surveillance blood cultures as an alternative to antibiotic prophylaxis in the management of patients on ECLS. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00383-008-2299-1Authors Gregor W. Kaczala, The British Columbia Children’s Hospital Division of Neonatal Intensive Care, Department of Pediatrics 1R47-4480 Oak Street Vancouver BC V6H 3V4 CanadaStephane C. Paulus, The British Columbia Children’s Hospital Division of Infectious and Imm...

Atypical right diaphragmatic hernia (hernia of Morgagni), spigelian hernia and epigastric hernia in a patient with Williams syndrome: a case report

BioMed Central — Wed, 07 Jan 2009 05:00:00 +0100

Conclusion: These multiple hernias suggest that patients with Williams syndrome may have some connective tissue disorder which makes them prone to develop hernias especially associated with those parts of the body which may have intracavity pressure variations like the abdomen. Diaphragmatic hernia may be the cause of chest pain in these patients. A computed tomography scan helps in early diagnosis, and laparoscopic repair helps in prevention of further complications, and leads to quick recovery especially in patients with learning disabilities. In the presence of significant comorbidities, a less invasive operative procedure with quick recovery becomes advisable. (Source: BioMed Central)

Analysis of 29 consecutive thoracoscopic repairs of congenital diaphragmatic hernia in neonates compared to historical controls

Journal of Pediatric Surgery — Thu, 01 Jan 2009 05:00:00 +0100

Conclusions: To our knowledge, this is the largest reported series of CDH-T of neonatal CDH of Bochdalek. We have demonstrated the feasibility of performing this procedure thoracoscopically in an unselected population including children who have undergone prior extracorporeal life support. These results compare favorably with CDH-O, although further follow-up is required to determine the durability of the approach. (Source: Journal of Pediatric Surgery)

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Identifying neonates at a very high risk for mortality among children with congenital diaphragmatic hernia managed with extracorporeal membrane oxygenation

Journal of Pediatric Surgery — Thu, 01 Jan 2009 05:00:00 +0100

Conclusion: Scoring 15 or higher on the prediction score identifies neonates with CDH at a very high risk for mortality among those managed with ECMO and could be used in surgical decision making and counseling. (Source: Journal of Pediatric Surgery)

Esophageal atresia surgery in the 21st century.

Seminars in Pediatric Surgery — Fri, 26 Dec 2008 03:53:52 +0100

Authors: Mackinlay GA The results of thoracoscopic repair of oesophageal atresia with or without tracheo-oesophageal fistula are presented. Twenty-six children had the repair perfomed thoracoscopically (22 in Edinburgh and 4 by Edinburgh surgeons in other institutions). Twenty infants had oesophageal atresia with tracheo-oesophageal fistula and 6 had isolated oesophageal atresia without fistula. Details of the technique are presented. Birth weights ranged from 1.4 to 3.9 kg and children were operated between 1 day and three months of age. There were 7 minor anastomotic leaks all managed conservatively, 1 recurrent fistula managed thoracoscopically and 9 anastomotic strictures. One child had a tracheo-bronchial fistula not seen at original thoracoscopy. There were 3 deaths (one child wi...

Thoracoscopic Repair of Neonatal Diaphragmatic Hernia

Journal of Laparoendoscopic — Tue, 23 Dec 2008 15:49:32 +0100

In this report, we describe our initial experience with ... (Source: Journal of Laparoendoscopic)

Congenital diaphragmatic hernia: current status and review of the literature

European Journal of Pediatrics — Tue, 23 Dec 2008 07:31:48 +0100

Abstract Treatment of congenital diaphragmatic hernia (CDH) challenges obstetricians, pediatric surgeons, and neonatologists. Persistent pulmonary hypertension (PPHT) associated with lung hypoplasia in CDH leads to a high mortality rate at birth. PPHT is principally due to an increased muscularization of the arterioles. Management of CDH has been greatly improved by the introduction of prenatal surgical intervention with tracheal obstruction (TO) and by more appropriate postnatal care. TO appears to accelerate fetal lung growth and to increase the number of capillary vessels and alveoli. Improvement of postnatal care over the last years is mainly due to the avoidance of lung injury by applying low peak inflation pressure during ventilation. The benefits of other drugs or t...

Instrumental requirements for minimal invasive fetal surgery.

BJOG : An International Journal of Obstetrics and Gynaecology — Thu, 18 Dec 2008 08:36:49 +0100

Authors: Klaritsch P, Albert K, Van Mieghem T, Gucciardo L, Done' E, Bynens B, Deprest J Minimal invasive intrauterine interventions have gained their place in fetal medicine. Interventions on the placenta, umbilical cord, fetal membranes or on the fetus require special endoscopes with their respective sheaths, cannulas and additional instruments. Instruments for fetal therapy are purpose designed for the procedure of interest and most gynaecologists are therefore not familiar with them. We review the currently available instrumentation used during operations for complicated monochorionic multiple pregnancies, congenital diaphragmatic hernia, amniotic band syndrome, urinary tract obstruction and hydrothorax. PMID: 19076951 [PubMed - in process] (Source: BJOG : An International Jour...

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Hemothorax- a rare presentation of congenital strangulated diaphragmatic hernia

Indian Journal of Pediatrics — Fri, 05 Dec 2008 09:17:59 +0100

We report the case of a 7 years old previously asymptomatic child who initially presented with respiratory distress because of massive left-sided hemothorax but was subsequently diagnosed to be having strangulated small intestine through a diaphragmatic rent on laparotomy. The case is being discussed in detail and the possible causes of hemothorax in such a scenario discussed. Content Type Journal ArticleCategory Clinical BriefDOI 10.1007/s12098-008-0223-2Authors Rakesh Mondal, Institute of Post Graduate Medical Education and Research and SSKM Hospital Department of Pediatric Medicine Kolkata West Bengal IndiaMadhumita Nandi, Institute of Post Graduate Medical Education and Research and SSKM Hospital Department of Pediatric Medicine Kolkata West Bengal IndiaDipankar Gupta, Institute...

Improvement in oxygenation with return of spontaneous ventilation during repair of congenital diaphragmatic hernia.

Paediatric Anaesthesia — Mon, 01 Dec 2008 05:00:00 +0100

Authors: Umesh G, Swati V, Saranya R, Daniel TA, Jasvinder K PMID: 19076598 [PubMed - in process] (Source: Paediatric Anaesthesia)

Permacol: a potential biologic patch alternative in congenital diaphragmatic hernia repair

Journal of Pediatric Surgery — Thu, 27 Nov 2008 19:45:13 +0100

Conclusion: Our results suggest that Permacol may have lower recurrence rates compared to Gore-Tex and is a promising alternative biologic graft for CDH repair. (Source: Journal of Pediatric Surgery)

Radiographic changes in the diaphragm after repair of congenital diaphragmatic hernia

Journal of Pediatric Surgery — Thu, 27 Nov 2008 19:45:12 +0100

Conclusion: The growth of the repaired diaphragm may be impaired, which contributes to decreased perfusion of the ipsilateral lung and scoliosis. The LLD and DD are simple but useful parameters in the follow-up of patients with CDH. (Source: Journal of Pediatric Surgery)

Maternal administration of betamethasone inhibits proliferation induced by fetal tracheal occlusion in the nitrofen rat model for congenital diaphragmatic hernia: a placebo-controlled study

Pediatric Surgery International — Fri, 14 Nov 2008 07:59:23 +0100

Conclusion Rats with NF-induced CDH have hypoplastic lungs with normal proliferation indices. TO triggers proliferation, an effect countered by BM. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00383-008-2269-7Authors Steffi Mayer, Katholieke Universiteit Leuven Faculty of Medicine, Centre for Surgical Technologies Minderbroedersstraat 17 3000 Leuven BelgiumPhilipp Klaritsch, Katholieke Universiteit Leuven Faculty of Medicine, Centre for Surgical Technologies Minderbroedersstraat 17 3000 Leuven BelgiumLourenço Sbragia, Katholieke Universiteit Leuven Faculty of Medicine, Centre for Surgical Technologies Minderbroedersstraat 17 3000 Leuven BelgiumJaan Toelen, Katholieke Universiteit Leuven Laboratory of Molecular Virology and Gene Therapy Kapucijnenv...

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Congenital Diaphragmatic Hernia in the Newborn

Irish Journal of Medical Science — Sun, 09 Nov 2008 09:53:43 +0100

Abstract A ten year review (1980–1989) of 59 neonates presenting with congenital diaphragmatic hernia (CDH) to Our Lady’s Hospital for Sick Children, the main referral centre for neonatal surgery in Ireland, is presented to determine the outcome and make suggestions for improvements. CDH was more common in males (34M, 25F). The hernia was present on the left side in 47 cases and 11 cases were right sided. Overall mortality was 35.6%, with increased mortality for right-sided hernia (54.5%). Mean gestation period for survivors was 39 weeks and for non-survivors was 36 weeks. Fifty-two (88.1%) patients presented with symptoms within first six hours after birth. Nineteen of 59 patients (32%) did not have their airways secured with an endotracheal tube at the time of arriva...

Significance of pulmonary artery size and blood flow as a predictor of outcome in congenital diaphragmatic hernia

Pediatric Surgery International — Thu, 06 Nov 2008 00:34:03 +0100

Conclusion Our data indicate that PA diameters on day 0 and LPA flow are strongly prognostic in left-sided CDH and L/R ratio would appear to be a simple highly reliable indicator of the necessity for NO therapy. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00383-008-2266-xAuthors Tadaharu Okazaki, Juntendo University School of Medicine Department of Pediatric Surgery 2-1-1 Hongo Bunkyo-Ku Tokyo 113-8421 JapanManabu Okawada, Juntendo University School of Medicine Department of Pediatric Surgery 2-1-1 Hongo Bunkyo-Ku Tokyo 113-8421 JapanSatoko Shiyanagi, Juntendo University School of Medicine Department of Pediatric Surgery 2-1-1 Hongo Bunkyo-Ku Tokyo 113-8421 JapanHiromichi Shoji, Juntendo University School of Medicine Department of Pediatrics Bunky...

Minimally invasive pediatric surgery: Our experience

Journal of Indian Association of Pediatric Surgeons — Sat, 01 Nov 2008 10:08:02 +0100

Conclusion:</b> The minimally invasive pediatric surgical technique is increasingly accepted world wide and the need for laparoscopic training has become essential in every teaching hospital. It has a lot of advantages, such as less pain, early return to school and scarlessness. Our conversion rate has come down from 5% to 3% with experience and now we do more advanced procedures with a lower complication rate. (Source: Journal of Indian Association of Pediatric Surgeons)

Congenital diaphragmatic hernia: a modern day approach.

Seminars in Pediatric Surgery — Sat, 01 Nov 2008 04:00:00 +0100

Authors: Waag KL, Loff S, Zahn K, Ali M, Hien S, Kratz M, Neff W, Schaffelder R, Schaible T Centralization of all complicated congenital diaphragmatic hernias (CDH) was organized in Germany from 1998, collecting 325 consecutive patients with striking increasing survival rates. This series report 244 patients from 2002 to 2007. Today, large defects are detected early in pregnancy by ultrasound and magnetic resonance imaging (MRI). In extracorporeal membrane oxygenation (ECMO) patients, prenatal lung head ratio (LHR) was 1.2 (median) at the 34th week of gestation or less than 25 ml lung tissue in MRI. This means that all patients below LHR of 1.4 should be transferred prenatally in a tertiary center. High risk group for survival was defined as LHR below 0.9, ie, 10 ml in MRI planimetry. ...

Abnormal development of tracheal innervation in rats with experimental diaphragmatic hernia

Pediatric Surgery International — Wed, 29 Oct 2008 07:05:13 +0100

Conclusions The development of intrinsic innervation of the trachea in rats with CDH is abnormal with reduction of neural tissue accompanied by increase of glial tissue that could represent a response to neural damage. The significance of increased PGP 9.5 mRNA levels is unclear. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00383-008-2261-2Authors Federica Pederiva, Hospital Universitario La Paz Department of Pediatric Surgery and Research Laboratory Paseo de la Castellana, 261 28046 Madrid SpainRosa Aras Lopez, Hospital Universitario La Paz Department of Pediatric Surgery and Research Laboratory Paseo de la Castellana, 261 28046 Madrid SpainLeopoldo Martinez, Hospital Universitario La Paz Department of Pediatric Surgery and Research Laboratory Pa...

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Prenatal prediction of neonatal morbidity in survivors with congenital diaphragmatic hernia: a multicenter study

Ultrasound in Obstetrics and Gynecology — Thu, 09 Oct 2008 04:00:00 +0100

To investigate the value of the observed to expected fetal lung area to head circumference ratio (o/e LHR) and liver position in the prediction of neonatal morbidity in survivors with congenital diaphragmatic hernia (CDH).Neonatal morbidity was recorded in 100 consecutive cases with isolated CDH diagnosed in fetal medicine units, which were expectantly managed in the prenatal period, were delivered after 30 weeks and survived until discharge from hospital. Regression analysis was used to identify the significant predictors of morbidity, including prenatal and immediate neonatal findings.The o/e LHR provided significant prediction of the need for prosthetic patch repair, duration of assisted ventilation, need for supplemental oxygen at 28 days, and incidence of feeding problems. An addition...

Prenatal prediction of neonatal morbidity in survivors with congenital diaphragmatic hernia: a multicenter study.

The Ultrasound Review of Obstetrics and Gynecology — Thu, 09 Oct 2008 04:00:00 +0100

CONCLUSIONS: In isolated CDH the prenatally assessed size of the contralateral lung is a significant predictor of the need for prosthetic patch repair, the functional consequences of impaired lung development and occurrence of feeding problems. Copyright (c) 2008 ISUOG. Published by John Wiley & Sons, Ltd. PMID: 18844275 [PubMed - as supplied by publisher] (Source: The Ultrasound Review of Obstetrics and Gynecology)

Congenital Diaphragmatic Hernia. The Post-Neonatal Period (Part II)

European Journal of Pediatric Surgery — Wed, 08 Oct 2008 15:53:50 +0100

Eur J Pediatr SurgDOI: 10.1055/s-2008-1038606Abstract The aim of this study was to describe the long-term functional impact of congenital diaphragmatic hernia repair on the survivors of a cohort of newborns. We analysed the multidisciplinary follow-up medical charts of 26 congenital diaphragmatic hernia survivors, treated at the Hospital de São João neonatal intensive care unit from January 1997 to December 2006. The median age at follow-up was 51 (14 – 141) months. One (4 %) patient had died by the age of three months old. Thirteen (50 %) patients presented with at least one sequelae, six (23 %) presented with two or more. Gastrointestinal problems were the most prevalent, with 6 (23 %) children below the fifth percentile for weight and 3 (12...

The long-term follow-up of patients with a congenital diaphragmatic hernia: a broad spectrum of morbidity

Pediatric Surgery International — Wed, 08 Oct 2008 12:14:01 +0100

Abstract Congenital diaphragmatic hernia (CDH) is a life-threatening anomaly with a mortality rate of approximately 40–50%, depending on case selection. It has been suggested that new therapeutic modalities such as nitric oxide (NO), high frequency oxygenation (HFO) and extracorporal membrane oxygenation (ECMO) might decrease mortality associated with pulmonary hypertension and the sequelae of artificial ventilation. When these new therapies indeed prove to be beneficial, a larger number of children with severe forms of CDH might survive, resulting in an increase of CDH-associated complications and/or consequences. In follow-up studies of infants born with CDH, many complications including pulmonary damage, cardiovascular disease, gastro-intestinal disease, failure to th...

Congenital cardiac malformations in neonates with apparently isolated gastrointestinal malformations

Pediatrics International — Mon, 06 Oct 2008 04:00:00 +0100

Conclusion: A significant number of neonates with apparently isolated gastrointestinal malformations had CCM. Because almost all patients with malformations of the gastrointestinal tract/abdominal wall require early surgical intervention, they should be evaluated on echocardiography to investigate CCM at the earliest opportunity. (Source: Pediatrics International)

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Minimally invasive congenital diaphragmatic hernia repair: a 7-year review of one institution’s experience

Surgical Endoscopy — Thu, 02 Oct 2008 09:28:48 +0100

Conclusions Morgagni hernias can be managed successfully by laparoscopy, whereas thoracoscopy is preferred for neonatal Bochdalek hernias. Either approach can be successful for infants and children with Bochdalek hernias. Additionally, patients with congenital cardiac defects and those requiring prosthetic patches can undergo a MIS CDH repair with a successful outcome. Content Type Journal ArticleDOI 10.1007/s00464-008-0143-2Authors Sohail R. Shah, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center Division of Pediatric General and Thoracic Surgery 3705 Fifth Avenue, 4A-485 Pittsburgh PA 15213 USAJessica Wishnew, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center Division of Pediatric General and Thoracic Surgery 370...

Fetal tracheal occlusion for severe congenital diaphragmatic hernia in humans: a morphometric study of lung parenchyma and muscularization of pulmonary arterioles

Journal of Pediatric Surgery — Wed, 01 Oct 2008 04:00:00 +0100

Abstract: Objective: The aim of this study is to examine structure of lung parenchyma (Pp) and muscularization of pulmonary arterioles (PAs) in human fetuses that underwent tracheal occlusion (TO) therapy for severe congenital diaphragmatic hernia (CDH).Material: Fifteen fetuses underwent TO, with 5 survivors (Am J Obstet Gynecol. 2000:183;1059-1066). Paraffin-embedded lung specimens from 7 of 10 nonsurvivors (CDH-TO) and 6 age-matched fetuses (CDH) were available for morphometric analysis, which included measurements of point fraction of lung Pp and surface density. The PAs were categorized according to external diameter ( (Source: Journal of Pediatric Surgery)

Platelet-derived growth factor inhibition—a new treatment of pulmonary hypertension in congenital diaphragmatic hernia?

Journal of Pediatric Surgery — Wed, 01 Oct 2008 04:00:00 +0100

Abstract: Increased pulmonary vascular resistance causing pulmonary artery hypertension is a major problem in the treatment of congenital diaphragmatic hernia with a strong association to mortality. We here report a patient with intractable pulmonary hypertension at 4 weeks of age unresponsive to conventional treatment. After administration of the platelet-derived growth factor (PDGF) receptor antagonist imatinib, pulmonary artery pressure gradually decreased to acceptable levels and the patient's clinical condition gradually improved. (Source: Journal of Pediatric Surgery)

Abdominal compartment syndrome post- late Bochdalek hernia repair: a case report

Cases Journal — Tue, 30 Sep 2008 04:00:00 +0100

The aim of this case report is to discuss the rare postoperative complication of abdominal compartment syndrome in a 19-year-old Caucasian Greek male that was electively operated on for a congenital diaphragmatic hernia. The hernia was completely asymptomatic and was found in chest radiography for employment reasons. Abdominal compartment syndrome is related in most reports with trauma and abdominal operations. Timely diagnosis is key to the prevention of further organ damage and multisystem organ dysfunction because the syndrome once instituted is highly fatal. (Source: Cases Journal)

The outcome in newborns with congenital diaphragmatic hernia in a Norwegian region

Acta Paediatrica — Mon, 15 Sep 2008 04:00:00 +0100

Conclusion: Pulmonary hypoplasia and pulmonary hypertension are still the most challenging factors in treatment of neonates with CDH, despite novel therapeutic modalities, such as HFV, surfactant and iNO. Delayed surgery in CDH allows pre-operative stabilization. Extracorporeal membrane oxygenation must be considered in the most severe cases. (Source: Acta Paediatrica)

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Preventive Antireflux Surgery in Patients with Congenital Diaphragmatic Hernia

World Journal of Surgery — Fri, 12 Sep 2008 08:10:04 +0100

Conclusions Based on the published data, recommendations can be made regarding the efficacy of adding an antireflux surgery procedure to left CDH repair in only patients with intrathoracic liver and/or patch requirement. Content Type Journal ArticleDOI 10.1007/s00268-008-9738-yAuthors Caroline Chamond, Hôpital Saint-Vincent de Paul Département de Chirurgie Pédiatrique 74-82 av Denfert-Rochereau 75014 Paris FranceMarianne Morineau, Hôpital Saint-Vincent de Paul Département de Chirurgie Pédiatrique 74-82 av Denfert-Rochereau 75014 Paris FranceGhania Gouizi, Hôpital Saint-Vincent de Paul Département de Chirurgie Pédiatrique 74-82 av Denfert-Rochereau 75014 Paris FranceFrederic Bargy, Hôpital Saint-Vincent de Paul Département de Chirurgie Pédiatrique 74-82 av D...

Congenital diaphragmatic hernia in a developing country.

Singapore Medical Journal — Mon, 01 Sep 2008 04:00:00 +0100

CONCLUSION: Greater than 50 percent survival of neonates with CDH was observed in a centre with conventional ventilation. Poor outcome is likely in neonates who present within 12 hours of life. PMID: 18830547 [PubMed - in process] (Source: Singapore Medical Journal)

Management of pulmonary hypertension in congenital diaphragmatic hernia: nitric oxide with prostaglandin-E1 versus nitric oxide alone

Pediatric Surgery International — Tue, 26 Aug 2008 08:16:06 +0100

Conclusion Nitric oxide alone would appear to simplify the management of CDH with PH and provide better outcome. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00383-008-2225-6Authors Satoko Shiyanagi, Juntendo University School of Medicine Department of Pediatric General and Urogenital Surgery 2-1-1 Hongo Bunkyo-ku Tokyo 113-8421 JapanTadaharu Okazaki, Juntendo University School of Medicine Department of Pediatric General and Urogenital Surgery 2-1-1 Hongo Bunkyo-ku Tokyo 113-8421 JapanHiromichi Shoji, Juntendo University School of Medicine Department of Pediatrics Bunkyo-ku Tokyo JapanToshiaki Shimizu, Juntendo University School of Medicine Department of Pediatrics Bunkyo-ku Tokyo JapanToshitaka Tanaka, Juntendo University School of Medicine Departm...

Thoracoscopic Repair for Right Congenital Diaphragmatic Hernia

Journal of Laparoendoscopic — Fri, 22 Aug 2008 13:01:36 +0100

Journal of Laparoendoscopic & Advanced Surgical Techniques Aug 2008, Vol. 18, No. 4: 661-663. Abstract Purpose: The aim of this study is to describe the surgical technique and initial results of thoracoscopic repair for the right congenital diaphragmatic hernia (CDH). Methods: Patients underwent surgery under conventional general anesthesia. The ... (Source: Journal of Laparoendoscopic)

Congenital Diaphragmatic Hernia – The Neonatal Period (Part I)

European Journal of Pediatric Surgery — Sun, 17 Aug 2008 13:14:58 +0100

Eur J Pediatr SurgDOI: 10.1055/s-2008-1038502Abstract The aim of the study was to review our experience in the management of newborns with congenital diaphragmatic hernia (CDH). A retrospective study including all infants with CDH at the Hospital de São João, a center that does not provide ECMO support, for the period from 1997 to 2006. Since 2003, a new treatment protocol has been used. There were 61 newborns (30 male/31 female) with a birth weight of 2800 g (880 – 3770), and a gestational age of 38 weeks (28 – 41); 46 (75 %) were inborn and 42 (69 %) had a prenatal diagnosis of CDH. There were 2 (3 %) chromosomal anomalies, 3 (5 %) with other congenital anomalies and 1 (2 %) with nonimmune hydrops fetalis. The diap...

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The impact of strict infection control on survival rate of prenatally diagnosed isolated congenital diaphragmatic hernia

Pediatric Surgery International — Fri, 15 Aug 2008 06:42:00 +0100

Conclusion The new supportive therapy with strict infection control improved survival rate of prenatally diagnosed CDH without using ECMO. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00383-008-2226-5Authors Nobuyuki Morikawa, National Center For Child Health and Development Division of General Surgery 2-10-1 Okura, Setagaya-ku Tokyo 157-8535 JapanTatsuo Kuroda, National Center For Child Health and Development Division of General Surgery 2-10-1 Okura, Setagaya-ku Tokyo 157-8535 JapanToshiro Honna, National Center For Child Health and Development Division of General Surgery 2-10-1 Okura, Setagaya-ku Tokyo 157-8535 JapanYoshihiro Kitano, Saitama Children’s Medical Center Division of General Surgery Saitama JapanHajime Takayasu, National Center For ...

Pediatric laparoscopy.

AORN Journal — Fri, 01 Aug 2008 04:00:00 +0100

Authors: Harrington S, Simmons K, Thomas C, Scully S Significant developments in minimally invasive surgery (MIS) for the adult population have led to increased application of MIS techniques for pediatric patients. Laparoscopy is the most common mis procedure used in pediatrics. Traditional surgical procedures that are now being performed laparoscopically include gastrostomy, pyloromyotomy, and repair of congenital diaphragmatic hernia and imperforate anus. All perioperative team members must be prepared to provide appropriately sized instruments and equipment to facilitate use of MIS techniques in the pediatric population and must ensure safe patient care to achieve optimal patient outcomes. PMID: 18782939 [PubMed - in process] (Source: AORN Journal)

NKCC-1 and ENaC are down-regulated in nitrofen-induced hypoplastic lungs with congenital diaphragmatic hernia

Pediatric Surgery International — Thu, 31 Jul 2008 06:56:38 +0100

Abstract Congenital diaphragmatic hernia (CDH) is accompanied by pulmonary hypoplasia and pulmonary hypertension. Fetal lung growth is dependent on the secretion of lung liquid, which normally is absorbed at partus. The ion channel NKCC-1 is involved in this secretory process, but has recently also been reported to be implicated in absorption. CDH patients show a disturbed transition from secretion to absorption. α- and β-ENaC are essential for lung liquid absorption. Common for all transcellular ion transport is the need for Na/K-ATPase as a primary driving force. The aim of the study was first to map the normal pulmonary expression of the above proteins during late gestation and secondly to see if the expression was affected in a CDH rat model. Pregnant Sprague–Dawle...

Evaluation of diaphragmatic hernia repair using PLGA mesh–collagen sponge hybrid scaffold: an experimental study in a rat model

Pediatric Surgery International — Thu, 31 Jul 2008 06:56:30 +0100

Abstract Patch closure is necessary to achieve tension-free repair in large congenital diaphragmatic hernia. However, the use of prosthetic material may lead to granulation, allergic reaction, infection, recurrence of hernia, and thoracic deformity. Tissue engineering may become an alternative treatment strategy for diaphragmatic hernia repair, since the regenerated autologous tissue is expected to grow potentially without rejection or infection. We evaluated the efficacy of diaphragmatic hernia repair in a rat model using a poly-lactic-co-glycolic acid (PLGA) mesh–collagen sponge hybrid scaffold, designed for in situ tissue engineering. Twenty-four F344 female rats were used. Oval-shaped defects were surgically created in the left diaphragm and repaired with three differ...

[CASE REPORTS] Bilateral Intrathoracic Kidneys and Adrenal Glands Associated With Posterior Congenital Diaphragmatic Hernias

The Annals of Thoracic Surgery — Thu, 24 Jul 2008 04:00:00 +0100

We present a case of bilateral intrathoracic kidneys and adrenal glands associated with bilateral posterior diaphragmatic defects in a symptomatic 18-month-old baby boy. The diaphragmatic defect did not appear to be the typical posterolateral diaphragmatic hernia of Bochdalek. The patient underwent primary surgical correction through an abdominal approach. Postoperatively, the patient enjoyed an uneventful course and was discharged home without any further events. We discuss this report of bilateral intrathoracic kidneys associated with bilateral diaphragmatic hernias, we describe the operative management, and we analyze the possible embryological development of this defect. (Source: The Annals of Thoracic Surgery)

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Bilateral intrathoracic kidneys and adrenal glands associated with posterior congenital diaphragmatic hernias.

The Annals of Thoracic Surgery — Wed, 23 Jul 2008 09:59:33 +0100

Minimally invasive surgery in infants less than 5 kg: experience of 649 cases

Surgical Endoscopy — Wed, 23 Jul 2008 05:55:22 +0100

Conclusions The development of modern low-flow CO2 insufflators, smaller instruments and telescopes, as well as advanced techniques, has made MIS in neonates feasible and safe. The greatest challenge remains performing intestinal anastomosis in these confined spaces, and further technical advances will be required to make these techniques universally adopted. Content Type Journal ArticleDOI 10.1007/s00464-008-0025-7Authors Todd A. Ponsky, Rocky Mountain Hospital for Children Denver CO USASteven S. Rothenberg, Rocky Mountain Hospital for Children Denver CO USA Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794 (Source: Surgical Endoscopy)

Vincent Alexander Bochdalek (1801–1883)

World Journal of Surgery — Sat, 19 Jul 2008 13:57:21 +0100

Abstract Vincent Alexander Bochdalek, Czech anatomist and professor, was one of the pioneers in describing congenital diaphragmatic hernias in newborns. Interestingly, there is very little in the literature and almost nothing in the English literature regarding this important medical figure. A dedicated individual, Bochdalek had great perseverance, which allowed him to surpass obstacles in both his personal life and career. He is recognized for his accurate description of posterior diaphragmatic herniation, for which during his lifetime, there was no treatment. In addition, Bochdalek has multiple eponyms in his honor: ganglion Bochdalecki, Bochdalek’s basket, and the valves of Bochdalek. Always steadfast in his beliefs, Bochdalek fought for the creation of anatomy labs i...

Jarcho-Levin Syndrome Presenting with Diaphragmatic Hernia

European Journal of Pediatric Surgery — Wed, 16 Jul 2008 12:54:47 +0100

We report on a 6-day-old girl who presented with an incomplete form of Jarcho-Levin syndrome with late-presenting congenital diaphragmatic hernia and congenital heart disease.[...]© Georg Thieme Verlag KG Stuttgart · New YorkGet connected:Table of contents | Abstract | Full text (Source: European Journal of Pediatric Surgery)

Thoracoscopic patch repair of a right-sided congenital diaphragmatic hernia in a neonate

Surgical Endoscopy — Tue, 15 Jul 2008 07:05:25 +0100

Conclusions As demonstrated by our video, large right-sided congenital diaphragmatic hernias requiring patch repair can be successfully repaired thoracoscopically with appropriate surgeon comfort and experience. This minimally invasive approach may also be used in neonates with associated cardiac defects with appropriate cardiothoracic surgical consultation and support. To our knowledge this is the first reported case of a thoracoscopic repair of a Bochdalek (posterolateral) hernia with a prosthetic patch in a neonate with significant congenital cardiac anomalies. Content Type Journal ArticleCategory Multimedia ManuscriptDOI 10.1007/s00464-008-0071-1Authors Sohail R. Shah, University of Pittsburgh Medical Center Division of Pediatric General and Thoracic Surgery, Ch...

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Prenatal diagnosis of ectopic intrathoracic kidney in a fetus with a left diaphragmatic hernia

Journal of Clinical Ultrasound — Wed, 09 Jul 2008 04:00:00 +0100

We present a case in which the prenatal diagnosis of an ectopic intrathoracic kidney was made on routine anatomical survey at 28 weeks' gestation. Color doppler sonography imaging revealed the renal artery coursing into the infant's thorax and was consistent with CDH, but fetal MRI suggested an intact diaphragm. However, neonatal evaluation confirmed the diagnosis of intrathoracic kidney with posterior CDH, which was repaired without complication. In contrast to diaphragmatic hernia with liver or bowel herniation, infants with intrathoracic ectopic kidneys generally do well. © 2008 Wiley Periodicals, Inc. J Clin Ultrasound, 2008 (Source: Journal of Clinical Ultrasound)

Right-sided Intrathoracic Renal Ectopia With Bochdalek's Hernia.

Urology — Wed, 02 Jul 2008 04:00:00 +0100

Authors: Subramanian VS, Goldfarb DA A 23-year-old woman was evaluated for right flank pain of one year duration. Magnetic resonance imaging (MRI) revealed a 6 cm defect in the right hemidiaphragm with herniation of the right kidney, adrenal gland, and posterior right hepatic lobe consistent with a congenital right Bochdalek hernia. Computed tomography (CT) urogram confirmed lack of masses, hydronephrosis, and renal calculi and defined vascular and ureteral anatomy through the diaphragmatic hernia. Intrathoracic kidney is rare and is usually discovered incidentally. In the absence of other renal pathology it requires no surgical intervention. PMID: 18602150 [PubMed - as supplied by publisher] (Source: Urology)

[Antenatal treatment of congenital diaphragmatic hernia: An update.]

Archives de Pediatrie — Fri, 27 Jun 2008 04:00:00 +0100

Authors: Mitanchez D Despite advances in neonatal care, the associated mortality in isolated congenital diaphragmatic hernia remains in the order of 30%. Death is mainly due to consecutive pulmonary hypoplasia and severe associated pulmonary hypertension. This statement led to the implement of fetal therapy in order to improve fetal lung development. The first phase of fetal surgery consisted in open repair with one-stage surgical correction of the anatomic defect. It was followed by tracheal occlusion technique based on the decrease egress of lung fluid in order to improve lung growth. Initial approach of tracheal occlusion used clips on the trachea. It is now performed with intra-tracheal inflatable balloon. The challenge of such prenatal treatment is to establish accurate prenatal p...

Fetal Tracheal Occlusion for the Treatment of Congenital Diaphragmatic Hernia

World Journal of Surgery — Mon, 16 Jun 2008 06:06:45 +0100

Content Type Journal ArticleDOI 10.1007/s00268-008-9642-5Authors Jean-Martin Laberge, McGill University, The Montreal Children’s Hospital of the McGill University Health Centre 2300 Tupper Street Montreal QC Canada H3H 1P3 Journal World Journal of SurgeryOnline ISSN 1432-2323Print ISSN 0364-2313 (Source: World Journal of Surgery)