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Annals of the Royal College of Surgeons... Sep 2017Diaphragmatic eventration is an uncommon condition, usually discovered incidentally in asymptomatic patients. Even in symptomatic patients, the diagnosis can be... (Review)
Review
Diaphragmatic eventration is an uncommon condition, usually discovered incidentally in asymptomatic patients. Even in symptomatic patients, the diagnosis can be challenging and should be considered among the differential diagnoses of diaphragmatic hernia. The correct diagnosis can often only be made in surgery. We describe the case of a 31-year-old patient with diaphragmatic eventration that was misdiagnosed as a recurrent congenital diaphragmatic hernia and review the corresponding literature.
Topics: Adult; Diagnosis, Differential; Diagnostic Errors; Diaphragmatic Eventration; Hernia, Diaphragmatic; Hernias, Diaphragmatic, Congenital; Humans; Male; Radiography; Recurrence; Tomography, X-Ray Computed
PubMed: 28853592
DOI: 10.1308/rcsann.2016.0342 -
The Journal of Extra-corporeal... Sep 2010A previous review from our institution established clinically measured cut-points that defined the late implementation of extracorporeal membrane oxygenation (ECMO)... (Review)
Review
UNLABELLED
A previous review from our institution established clinically measured cut-points that defined the late implementation of extracorporeal membrane oxygenation (ECMO) correlating to increased mortality in neonatal and pediatric respiratory patients. Using the same methods, this review evaluates pediatric and neonatal cardiac and congenital diaphragmatic hernia (CDH) patients to determine if the same cut-points exist in this higher risk patient population. Neonatal and pediatric cardiac and CDH patients placed on ECMO between November 1989 and December 2008 were retrospectively reviewed to determine the first adjusted anion gap (AGc), the first venoarterial carbon dioxide (CO2) gradient (p[v-a]CO2), and the first Viability Index (AGc + p[v-a]CO2 = INDEX) on ECMO. These markers were then analyzed to identify the presence of specific cut-points that marked an increased risk of mortality. The timing of surgery was also reviewed to assess the surgical morbidity on survival. The review of neonatal and pediatric cardiac and CDH patients (n = 205) with an overall survival of 46% showed that all three markers were elevated to varying degrees in the expired patients (n = 110). Histograms identified the following specific cut-points for increased mortality: the AGc > or = 23 mEq/L, the p[v-a]CO2 _ 16 mmHg, and the INDEX > or = 28. An elevated AGc and INDEX correlated with a significantly higher risk for mortality (p < .05), survival to discharge being 20% or less. Patients under the cut-points had survival rates of 51% or higher. The timing of surgery (before or after ECMO initiation) did not significantly impact survival in the combined cardiac and CDH group. An INDEX > or = 28 correlates with non-survival. We speculate that the late implementation of ECMO may lead to reperfusion injury, which causes reduced survival, and that ECMO intervention prior to reaching the cut-points may improve survival in neonatal and pediatric cardiac and CDH patients.
KEYWORDS
cardiac, congenital, diaphragmatic, extracorporeal membrane oxygenation, neonate, pediatric.
Topics: Child; Extracorporeal Membrane Oxygenation; Heart Defects, Congenital; Hernia, Diaphragmatic; Hernias, Diaphragmatic, Congenital; Humans; Infant, Newborn; Risk Factors; Survival Rate
PubMed: 21114220
DOI: No ID Found -
Pediatric Surgery International Jul 2008Congenital diaphragmatic hernia (CDH) is a major life-threatening cause of respiratory failure in the newborn. Recent data reveal the role of a retinoid-signaling... (Review)
Review
Congenital diaphragmatic hernia (CDH) is a major life-threatening cause of respiratory failure in the newborn. Recent data reveal the role of a retinoid-signaling pathway disruption in the pathogenesis of CDH. We describe the epidemiology and pathophysiology of human CDH, the metabolism of retinoids and the implications of retinoids in the development of the diaphragm and lung. Finally, we describe the existing evidence of a disruption of the retinoid-signaling pathway in CDH.
Topics: Hernia, Diaphragmatic; Hernias, Diaphragmatic, Congenital; Humans; Infant, Newborn; Retinoids; Signal Transduction
PubMed: 18401587
DOI: 10.1007/s00383-008-2140-x -
Postgraduate Medical Journal Nov 1986
Topics: Diaphragm; Hernia, Diaphragmatic; Humans; Male; Middle Aged; Time Factors
PubMed: 3628157
DOI: 10.1136/pgmj.62.733.1067 -
Annals of Surgery Aug 1948
Topics: Hernia, Diaphragmatic; Hernia, Hiatal; Humans
PubMed: 17859191
DOI: 10.1097/00000658-194808000-00004 -
Experimental and Clinical... Oct 2015Diaphragmatic hernia is an unusual complication after pediatric liver transplant. Nearly half of bowel obstruction cases, which require surgical intervention in liver...
Diaphragmatic hernia is an unusual complication after pediatric liver transplant. Nearly half of bowel obstruction cases, which require surgical intervention in liver transplant patients, are caused by diaphragmatic hernia. The smaller patients are at risk for higher rates of diaphragmatic complication after pediatric liver transplant, but diaphragmatic hernia has not been reported as a unique occurrence. Here, we report 3 cases of diaphragmatic hernia after liver transplant and discuss the possible contributing factors. Diaphragmatic hernia should nevertheless be added to the list of potential complications after liver transplant in the pediatric population. Pediatric transplant physicians and surgeons should be aware of this complication so that it is recognized promptly in both acute and nonacute settings and appropriate action is taken.
Topics: Age Factors; Child, Preschool; Female; Hernia, Diaphragmatic; Herniorrhaphy; Humans; Infant; Liver Transplantation; Male; Reoperation; Risk Factors; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 26450470
DOI: No ID Found -
Radiologia 2023A diaphragmatic hernia is the protrusion of abdominal tissues into the thoracic cavity secondary to a defect in the diaphragm. Reviewing the literature, we found only 44... (Review)
Review
A diaphragmatic hernia is the protrusion of abdominal tissues into the thoracic cavity secondary to a defect in the diaphragm. Reviewing the literature, we found only 44 references to diaphragmatic hernia secondary to percutaneous radiofrequency treatment. The vast majority of these cases were secondary to the treatment of hepatocellular carcinoma in segments V and VIII. Nevertheless, to date, this is the first reported case of diaphragmatic hernia after radiofrequency ablation of a liver metastasis from colorectal cancer. Complications secondary to diaphragmatic hernias are very diverse. The principal risk factor for complications is the contents of the hernia; when small bowel or colon segments protrude in the thoracic cavity, they can become incarcerated. Asymptomatic cases have also been reported in which the diaphragmatic hernia was discovered during follow-up. The pathophysiological mechanism is not totally clear, but it is thought that these diaphragmatic hernias might be caused by locoregional thermal damage. Given that most communications correspond to asymptomatic and/or treated cases, it is likely that the incidence is underestimated. However, due to the advent of percutaneous treatments, this complication might be reported more often in the future. Most cases are treated with primary herniorrhaphy, done with a laparoscopic or open approach at the surgeon's discretion; no evidence supports the use of one approach over the other. Nevertheless, it seems clear that surgery is the only definitive treatment, as well as the treatment of choice if complications develop. However, in asymptomatic patients in whom a diaphragmatic hernia is discovered in follow-up imaging studies, management should probably be guided by the patient's overall condition, taking into account the potential risks of complications (contents, diameter of the opening into the thoracic cavity …).
Topics: Humans; Hernia, Diaphragmatic; Liver Neoplasms; Carcinoma, Hepatocellular; Abdomen; Radiofrequency Ablation
PubMed: 36842789
DOI: 10.1016/j.rxeng.2021.09.012 -
Annals of Surgery Aug 1953
Topics: Diaphragm; Hernia, Diaphragmatic; Hernia, Hiatal; Humans
PubMed: 13066018
DOI: 10.1097/00000658-195308000-00014 -
Canadian Medical Association Journal Jul 1947
Topics: Hernia, Diaphragmatic; Hernia, Hiatal; Humans
PubMed: 20248221
DOI: No ID Found -
Postgraduate Medical Journal May 1986
Topics: Esophagitis, Peptic; Hernia, Diaphragmatic; Hernia, Diaphragmatic, Traumatic; Humans; Stomach Volvulus
PubMed: 3763538
DOI: 10.1136/pgmj.62.727.325