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Seminars in Pediatric Surgery May 2003Recurrent congenital diaphragmatic hernia (CDH) is a well-known complication, but one that has not been examined systematically. Review of the literature shows a varied... (Review)
Review
Recurrent congenital diaphragmatic hernia (CDH) is a well-known complication, but one that has not been examined systematically. Review of the literature shows a varied incidence as well as a myriad of treatment strategies. Evaluation of the available data is made more difficult by lack of standardized repair techniques and comparable patient groups. As an increasing number of diaphragmatic hernia patients survive the newborn period, a study of the true incidence of recurrent diaphragmatic hernia, its etiologic factors, and the methods of repair is essential to prevent and treat this problem.
Topics: Hernia, Diaphragmatic; Hernias, Diaphragmatic, Congenital; Humans; Infant; Recurrence; Reoperation
PubMed: 12728396
DOI: 10.1016/s1055-8586(02)00020-3 -
The Veterinary Clinics of North... Mar 1987This article describes the anatomy, etiology, and pathophysiology associated with congenital and traumatic diaphragmatic hernias. Suggestions on preoperative and... (Review)
Review
This article describes the anatomy, etiology, and pathophysiology associated with congenital and traumatic diaphragmatic hernias. Suggestions on preoperative and post-operative maintenance are presented as are various techniques for surgical correction.
Topics: Animals; Hernia, Diaphragmatic
PubMed: 3554712
DOI: 10.1016/s0195-5616(87)50033-x -
Paediatric Respiratory Reviews Dec 2002Congenital diaphragmatic hernia (CDH) is a lethal human birth defect. Hypoplastic lung development is the leading contributor to its 30-50% mortality rate. Efforts to... (Review)
Review
Congenital diaphragmatic hernia (CDH) is a lethal human birth defect. Hypoplastic lung development is the leading contributor to its 30-50% mortality rate. Efforts to improve survival have focused on fetal surgery, advances in intensive care and elective delivery at specialist centres following in utero diagnosis. The impact of abnormal lung development on affected infants has stimulated research into the developmental biology of CDH. Traditionally lung hypoplasia has been viewed as a secondary consequence of in utero compression of the fetal lung. Experimental evidence is emerging for a primary defect in lung development in CDH. Culture systems are providing research tools for the study of lung hypoplasia and the investigation of the role of growth factors and signalling pathways. Similarities between the lungs of premature newborns and infants with CDH may indicate a role for antenatal corticosteroids. Further advances in postnatal therapy including permissive hypercapnia and liquid ventilation hold promise. Improvements in our basic scientific understanding of lung development may hold the key to future developments in CDH care.
Topics: Female; Hernia, Diaphragmatic; Hernias, Diaphragmatic, Congenital; Humans; Infant, Newborn; Pregnancy
PubMed: 12457605
DOI: 10.1016/s1526-0542(02)00262-2 -
Cirugia Espanola Apr 2020
Topics: Aged, 80 and over; Hernia, Diaphragmatic; Humans; Male; Postoperative Complications; Tomography, X-Ray Computed
PubMed: 31164215
DOI: 10.1016/j.ciresp.2019.04.016 -
Current Problems in Surgery Oct 1994
Review
Topics: Hernia, Diaphragmatic; Hernias, Diaphragmatic, Congenital; Humans; Incidence; Prenatal Diagnosis; Prognosis
PubMed: 7924420
DOI: 10.1016/0011-3840(94)90028-0 -
Indian Journal of Pediatrics Sep 2000Over the last two decades there has been a constant improvement in the understanding of the pathophysiology of Congenital Diaphragmatic Hernia (CDH) and its management.... (Review)
Review
Over the last two decades there has been a constant improvement in the understanding of the pathophysiology of Congenital Diaphragmatic Hernia (CDH) and its management. However, the ideal treatment remains elusive. The earlier management strategy of immediate surgery is replaced by the principle of physiological stabilisation and delayed surgery. Conventional mechanical ventilatory techniques, with high pressures and hyperventilation to reverse ductal shunting and cause alkalinization, are being questioned because of the risks of barotrauma and consequent broncho-pulmonary dysplasia. It has also been shown that paralysis with pancuronium bromide for patients on conventional mechanical ventilation results in increased incidence of sensorineural hearing loss in childhood survivors of CDH. With the introduction of the concept of permissive hypercapnia and high frequency oscillation ventilation, the complications of pulmonary barotrauma are circumvented. Although ECMO therapy is invasive, yet has improved survival by about 15% independently, especially in critically ill infants who have the predictive mortality rate of more than 80%. Further insights into the pathophysiology of CDH and the introduction of less invasive therapeutic techniques in the form of high frequency oscillation ventilation, inhalation nitric oxide, surfactant, and perfluorocarbon liquid ventilation may even make the need for ECMO redundant.
Topics: Extracorporeal Membrane Oxygenation; Hernia, Diaphragmatic; Hernias, Diaphragmatic, Congenital; High-Frequency Ventilation; Humans; Infant, Newborn; Prenatal Diagnosis; Preoperative Care; Prognosis; Risk Factors; Survival Analysis
PubMed: 11028121
DOI: 10.1007/BF02762181 -
Pediatrics in Review Mar 1996
Topics: Hernia, Diaphragmatic; Hernias, Diaphragmatic, Congenital; Humans; Infant, Newborn; Postoperative Complications; Prognosis; Radiography; Risk Factors; Survival Rate
PubMed: 8685059
DOI: 10.1542/pir.17-3-102 -
Thoracic Surgery Clinics Nov 2009Bochdalek hernia is a rare surgical condition primarily diagnosed in infants. Morgagni hernia is more commonly identified in adults. A subset of patients with a... (Review)
Review
Bochdalek hernia is a rare surgical condition primarily diagnosed in infants. Morgagni hernia is more commonly identified in adults. A subset of patients with a Bochdalek hernia, especially those with a right-sided defect, may also be diagnosed during adulthood. Both adult forms of CDH may be discovered incidentally or diagnosed as part of the investigation of nonspecific gastrointestinal or respiratory symptoms. It is recommended that all adult CDH patients undergo surgical repair to prevent incarceration and strangulation of abdominal viscera. Currently, many reports have demonstrated the safety and efficacy of using open or minimally invasive repairtechniques, with or without mesh reinforcement. Regardless of the approach selected, surgical repair has been associated with low morbidity and mortality and excellent long-term outcomes with low rate of recurrence.
Topics: Adult; Hernia, Diaphragmatic; Hernias, Diaphragmatic, Congenital; Humans
PubMed: 20112629
DOI: 10.1016/j.thorsurg.2009.08.004 -
Seminars in Pediatric Surgery Nov 1996Understanding the complex multisystem dysfunction in the infant with a congenital hernia of the posterolateral diaphragm is still evolving and has changed radically... (Review)
Review
Understanding the complex multisystem dysfunction in the infant with a congenital hernia of the posterolateral diaphragm is still evolving and has changed radically during the last decade. The reduction in lung mass, in conjunction with surfactant deficiency and diminished compliance, leads to initial deficiencies in oxygenation and carbon dioxide (CO2) removal. This may then be potentiated by an extremely reactive hypoplastic pulmonary arterial system. Treatment no longer is focused on the operative repair but rather on the components of the pathophysiological process that are potentially reversible. Thus, extracorporeal membrane oxygenation and delay of repair until resolution of pulmonary artery hypertension have become mainstays of therapy and are probably responsible for increasing the survival rate in the patient who presents early with respiratory distress from 50% to 65%. Still far from acceptable, these results are giving impetus to new approaches to therapy including drugs such as nitric oxide, fetal intervention including open repair, and lung transplantation.
Topics: Extracorporeal Membrane Oxygenation; Hernia, Diaphragmatic; Hernias, Diaphragmatic, Congenital; Humans; Infant, Newborn
PubMed: 8936650
DOI: No ID Found -
Clinics in Perinatology Dec 1996Congenital diaphragmatic hernia is a relatively common birth defect. It affects about 1114 babies a year in the United States. Reported survival averages 60% but may be... (Review)
Review
Congenital diaphragmatic hernia is a relatively common birth defect. It affects about 1114 babies a year in the United States. Reported survival averages 60% but may be significantly lower. We do not understand the etiology of CDH. Its association with other anomalies and several distinct patterns of presentation suggest that more than one cause may exist. There is a high degree of variability in both treatment and outcomes, but no data exist to allow a rigorous comparison of the efficacy of various treatment strategies. Stratification of patients into more homogeneous groups will be a necessary prerequisite for the design of meaningful comparative trials. The incidence of the lesion prevents any single institution from accruing sufficient patients to conduct such a trial. An ad hoc multicenter study group (the Congenital Diaphragmatic Hernia Study Group) has been formed for this purpose. This organization has begun collecting data with an initial goal of developing a stratification scheme. Prospective data collection should allow verification of several of the estimates made in this article. Current data make it clear that CDH represents a major cause of perinatal morbidity and mortality.
Topics: Hernia, Diaphragmatic; Hernias, Diaphragmatic, Congenital; Humans
PubMed: 8982563
DOI: No ID Found