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Kyobu Geka. the Japanese Journal of... Sep 2022Traumatic diaphragmatic injury( TDI) is rare in traumas, however TDI is associated with high mortality. We follow the notation method by The Japanese Association for The...
Traumatic diaphragmatic injury( TDI) is rare in traumas, however TDI is associated with high mortality. We follow the notation method by The Japanese Association for The Surgery of Trauma. There are blunt trauma and penetrating trauma of TDI;blunt trauma causes mainly traffic accidents, and penetrating trauma is induced stub or gunshot. Penetrating trauma is more frequent than blunt trauma in Western countries, however there are mainly blunt traumas in Japan. The timing of diagnosis are three points;acute phase, subacute phase and delayed phase. In acute phase we often experienced unstable vital sign, so the patients of TDI need treatment immediately, however in delayed phase the patients of TDI are stable in vital signs. In order to diagnose for TDI, we use chest X-ray and computed tomography (CT), which is useful to diagnose by multi-planar reconstruction of multi-detector row CT. The ways to approach to TDI are from thoracotomy, laparotomy or both. When we repair the diaphragmatic injury, usually interrupted or horizontal mattress suture was applied with non-absorbable string. The mortality is about 8.8 to 19.8% by TDI, so we need to carefully diagnose TDI as soon as possible whether complication and abdominal viscera injury exist or not.
Topics: Diaphragm; Humans; Respiration Disorders; Retrospective Studies; Thoracic Injuries; Wounds, Nonpenetrating; Wounds, Penetrating
PubMed: 36155585
DOI: No ID Found -
The British Journal of Radiology Jul 2018The diaphragm is an unique skeletal muscle separating the thoracic and abdominal cavities with a primary function of enabling respiration. When abnormal, whether by... (Review)
Review
The diaphragm is an unique skeletal muscle separating the thoracic and abdominal cavities with a primary function of enabling respiration. When abnormal, whether by congenital or acquired means, the consequences for patients can be severe. Abnormalities that affect the diaphragm are often first detected on chest radiographs as an alteration in position or shape. Cross-sectional imaging studies, primarily CT and occasionally MRI, can depict structural defects, intrinsic and adjacent pathology in greater detail. Fluoroscopy is the primary radiologic means of evaluating diaphragmatic motion, though MRI and ultrasound also are capable of this function. This review provides an update on diaphragm embryogenesis and discusses current imaging of various abnormalities, including the emerging role of three-dimensional printing in planning surgical repair of diaphragmatic derangements.
Topics: Diaphragm; Humans
PubMed: 29485899
DOI: 10.1259/bjr.20170600 -
Journal of Neuromuscular Diseases 2018Respiratory muscles are classically involved in neuromuscular disorders, leading to a restrictive respiratory pattern. The diaphragm is the main respiratory muscle... (Review)
Review
Respiratory muscles are classically involved in neuromuscular disorders, leading to a restrictive respiratory pattern. The diaphragm is the main respiratory muscle involved during inspiration. Ultrasound imaging is a noninvasive, radiation-free, accurate and safe technique allowing assessment of diaphragm anatomy and function. The authors review the pathophysiology of diaphragm in neuromuscular disorders, the methodology and indications of diaphragm ultrasound imaging as well as possible pitfalls in the interpretation of results.
Topics: Diaphragm; Humans; Neuromuscular Diseases; Ultrasonography
PubMed: 29278898
DOI: 10.3233/JND-170276 -
Journal of Biomechanics Jun 2022A theoretical framework is developed for mechanics of the diaphragm. The diaphragm is modeled as an anisotropic elastic material surface with activation functionality. A...
A theoretical framework is developed for mechanics of the diaphragm. The diaphragm is modeled as an anisotropic elastic material surface with activation functionality. A constitutive function is formulated that relates the stresses in the diaphragm to the surface deformation gradient, the anisotropy vector, and the muscle activation parameter. The equilibrium equations for the diaphragm are derived to determine the deformed shape of the diaphragm in the process of respiration with the associated transdiaphragmatic pressures. A numerical solution is presented, that demonstrates the capability of the model to recover the experimental observations and to predict the shape and stresses of the diaphragm.
Topics: Anisotropy; Diaphragm; Pressure; Respiratory Mechanics; Thorax
PubMed: 35526434
DOI: 10.1016/j.jbiomech.2022.111090 -
Current Opinion in Obstetrics &... Dec 2020In the past few years, there have been great advances in contraceptive technology and development. Here we review advances in contraception over the past two years... (Review)
Review
PURPOSE OF REVIEW
In the past few years, there have been great advances in contraceptive technology and development. Here we review advances in contraception over the past two years including new medications, and technologies.
RECENT FINDINGS
Contraception must be discussed within the context of individual goals and context. New contraceptive options approved by the FDA in the past two years include a year-long vaginal ring, a progestin-only pill that is as effective as combined oral contraceptive pills, a new hormonal patch and a vaginal gel that may also help prevent sexually transmitted infections.There are still areas of contraceptive research that are very much unknown including biomarkers of contraceptive efficacy or side effects, how individuals or groups metabolize contraception, initiation around reproductive life events or the discontinuation of other methods.
SUMMARY
There have been many new contraceptives developed over the past few years to address challenges of existing contraception and create new methods; yet, there remain many unanswered questions in contraceptive research. Contraceptive technology has far-reaching consequences, and independent of technology itself, represents a great opportunity for truly personalized medicine.
Topics: Contraception; Contraceptive Agents; Contraceptive Devices, Female; Female; Humans; Research; Sexually Transmitted Diseases
PubMed: 32969852
DOI: 10.1097/GCO.0000000000000666 -
Clinical Obstetrics and Gynecology Dec 2014As birth spacing has demonstrated health benefits for a woman and her children, contraception after childbirth is recognized as an important health issue. The potential... (Review)
Review
As birth spacing has demonstrated health benefits for a woman and her children, contraception after childbirth is recognized as an important health issue. The potential risk of pregnancy soon after delivery underscores the importance of initiating postpartum contraception in a timely manner. The contraceptive method initiated in the postpartum period depends upon a number of factors including medical history, anatomic and hormonal factors, patient preference, and whether or not the woman is breastfeeding. When electing a contraceptive method, informed choice is paramount. The availability of long-acting reversible contraceptive methods immediately postpartum provides a strategy to achieve reductions in unintended pregnancy.
Topics: Amenorrhea; Birth Intervals; Breast Feeding; Condoms; Contraception; Contraceptive Agents, Female; Contraceptive Devices, Female; Contraceptives, Oral, Hormonal; Desogestrel; Drug Implants; Female; Humans; Intrauterine Devices, Copper; Levonorgestrel; Medroxyprogesterone Acetate; Postpartum Period; Sterilization, Tubal; Venous Thromboembolism
PubMed: 25264698
DOI: 10.1097/GRF.0000000000000055 -
Clinical Obstetrics and Gynecology Mar 2018Learning how to best meet a patient's contraceptive needs improves her chances of using her birth control consistently and is crucial to providing patient-centered care.... (Review)
Review
Learning how to best meet a patient's contraceptive needs improves her chances of using her birth control consistently and is crucial to providing patient-centered care. The best contraceptive method for an individual patient is the one that is safe and that she is most comfortable using. Women's health care providers must be equipped to talk to each patient about her needs and options. The shared decision-making model in contraceptive counseling allows the patient and provider to work together in order to meet a patient's needs while remaining medically safe.
Topics: Amenorrhea; Contraception; Contraceptive Agents, Female; Contraceptive Devices, Female; Counseling; Decision Making; Female; Humans; Patient-Centered Care; Postpartum Period; Sexual Abstinence; Sterilization; Women's Health
PubMed: 29283903
DOI: 10.1097/GRF.0000000000000337 -
Seminars in Perinatology Aug 2020In the context of medically complicated pregnancies, a "high risk patient" is an individual who is at increased risk for having a complicated pregnancy. These patients... (Review)
Review
In the context of medically complicated pregnancies, a "high risk patient" is an individual who is at increased risk for having a complicated pregnancy. These patients often experience limited contraceptive counseling and access, despite the fact that most effective contraceptive methods are associated with less risk than that of pregnancy. Free evidence-based resources are available to assist healthcare providers in discerning fact from myth about the risks of contraception. This review covers all available contraceptive methods, with particular focus on the benefits, risks, and attributes most relevant to high risk patients as well as the benefits and risks of initiating contraception post-pregnancy.
Topics: Condoms; Contraception; Contraceptive Agents; Contraceptive Devices, Female; Contraceptive Effectiveness; Contraceptives, Oral; Contraindications, Drug; Delayed-Action Preparations; Drug Implants; Female; Humans; Injections, Intramuscular; Injections, Subcutaneous; Intrauterine Devices; Long-Acting Reversible Contraception; Postpartum Period; Pregnancy; Pregnancy, High-Risk; Risk; Risk Assessment; Sterilization, Reproductive; Transdermal Patch
PubMed: 32624199
DOI: 10.1016/j.semperi.2020.151268 -
Thoracic Surgery Clinics May 2024The diaphragm is a musculoaponeurotic structure separating the thoracic and abdominal cavities. It plays important roles in both respiration and maintaining...
The diaphragm is a musculoaponeurotic structure separating the thoracic and abdominal cavities. It plays important roles in both respiration and maintaining gastrointestinal function. A careful consideration of anatomy should be taken during surgical procedures to minimize injury to this crucial organ.
Topics: Humans; Diaphragm
PubMed: 38705658
DOI: 10.1016/j.thorsurg.2024.01.002 -
World Journal of Surgery Jun 2015If morbidity and mortality are to be reduced in patients with penetrating abdominal trauma, first priority goes to prompt and accurate determination of peritoneal... (Review)
Review
If morbidity and mortality are to be reduced in patients with penetrating abdominal trauma, first priority goes to prompt and accurate determination of peritoneal penetration and identification of the need for surgery. In this setting, laparoscopy may have an important impact on the rate of negative or non-therapeutic laparotomies. We analyzed indications and patient selection criteria for laparoscopy in penetrating trauma along with outcomes. The analysis focused on identification of peritoneal penetration and injuries to the diaphragm, small intestine, and mesentery. Results from the early phase of laparoscopy were compared with those from recent decades with more advanced laparoscopic equipment and instruments and more experienced surgeons. A systematic review of the role of laparoscopy in penetrating abdominal trauma shows a sensitivity ranging from 66.7 to 100%, specificity from 33.3 to 100% and accuracy from 50 to 100%. Publications from the 1990s found trauma laparoscopy to be inadequate for detecting intestinal injuries and so to lead to missed injuries. Twenty-three of the 50 studies including the most recent ones report sensitivity, specificity, and accuracy of 100%. Laparoscopy is more cost effective than negative laparotomy. Laparoscopy can be performed safely and effectively on stable patients with penetrating abdominal trauma. The most important advantages are reduction of morbidity, accuracy in detecting diaphragmatic and intestinal injuries, and elimination of prolonged hospitalization for observation, so reducing the length of stay and increasing cost effectiveness.
Topics: Abdominal Injuries; Diagnostic Imaging; Diaphragm; Humans; Laparoscopy; Patient Selection; Wounds, Penetrating
PubMed: 25446491
DOI: 10.1007/s00268-014-2904-5