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El-Magd ESA, Elgeidie A, Abbas A, Elmahdy Y, LotfyAbulazm I, Hamed H. Laparoscopic approach in the management of diaphragmatic eventration in adults: gastrointestinal surgical perspective. Updates Surg 2024; 76:555-563. [PMID: 37847484 PMCID: PMC10995002 DOI: 10.1007/s13304-023-01665-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 09/29/2023] [Indexed: 10/18/2023]
Abstract
The current literature is poor with studies handling the role of laparoscopy in managing diaphragmatic eventration (DE). Herein, we describe our experience regarding the role of laparoscopy in managing DE patients presenting mainly with gastrointestinal symptoms. We retrospectively reviewed the data of 20 patients who underwent laparoscopic diaphragmatic plication between January 2010 and December 2018. Postoperative outcomes and quality of life were assessed. Most DEs were left sided (95%). Laparoscopic diaphragmatic plication was possible in all patients, along with correcting all associated gastrointestinal and diaphragmatic problems. The former included gastric volvulus (60%), reflux esophagitis (25%), cholelithiasis (5%), and pyloric obstruction (5%), while the latter included diaphragmatic and hiatus hernia (10% and 15%, respectively).The average operative time was 142 min. All patients had a regular (reviewer #1) postoperative course except for one who developed hydro-pneumothorax. At a median follow-up of 48 months, midterm outcomes were satisfactory, with an improvement (reviewer #1) in gastrointestinal symptoms. Three patients (reviewer #1) developed radiological recurrence without significant clinical symptoms. Patient's quality of life, including all parameters, significantly improved after the laparoscopic procedure compared to the preoperative values. Laparoscopic approach is safe and effective for managing adult diaphragmatic eventration (reviewer #1).
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Affiliation(s)
- El-Sayed Abou El-Magd
- Department of General Surgery, Faculty of Medicine, Gastrointestinal Surgical Center GISC, Mansoura University, Gehan Street, Mansoura, 35511, Al Dakahlia, Egypt.
| | - Ahmed Elgeidie
- Department of General Surgery, Faculty of Medicine, Gastrointestinal Surgical Center GISC, Mansoura University, Gehan Street, Mansoura, 35511, Al Dakahlia, Egypt
| | - Amr Abbas
- Department of General Surgery, Faculty of Medicine, Gastrointestinal Surgical Center GISC, Mansoura University, Gehan Street, Mansoura, 35511, Al Dakahlia, Egypt
| | - Youssif Elmahdy
- Department of General Surgery, Faculty of Medicine, Gastrointestinal Surgical Center GISC, Mansoura University, Gehan Street, Mansoura, 35511, Al Dakahlia, Egypt
| | - Ibrahem LotfyAbulazm
- Department of General Surgery, Faculty of Medicine, Gastrointestinal Surgical Center GISC, Mansoura University, Gehan Street, Mansoura, 35511, Al Dakahlia, Egypt
| | - Hosam Hamed
- Department of General Surgery, Faculty of Medicine, Gastrointestinal Surgical Center GISC, Mansoura University, Gehan Street, Mansoura, 35511, Al Dakahlia, Egypt
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Hebbale R, Ramachandran K, R V, Cherukumudi A. Congenital unilateral diaphragmatic eventration in adults – a case series with a brief literature review. HEART, VESSELS AND TRANSPLANTATION 2022. [DOI: 10.24969/hvt.2022.345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objective: The aim of this article was to present the results of thoracotomy performed in three symptomatic adult patients with congenital diaphragm eventration in the light of current literature data.
Methods: Along with representation of the surgical management of each case, a brief review of literature was performed.
Results and Conclusion: Diaphragmatic eventration is a rare clinical entity that may be congenital or acquired. Surgery, which may be open or endoscopic, is the primary treatment modality for symptomatic patients.
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Zhao S, Pan Z, Li Y, An Y, Zhao L, Jin X, Fu J, Wu C. Surgical treatment of 125 cases of congenital diaphragmatic eventration in a single institution. BMC Surg 2020; 20:270. [PMID: 33148241 PMCID: PMC7640684 DOI: 10.1186/s12893-020-00928-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 10/25/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study sought to investigate the clinical characteristics of congenital diaphragmatic eventration (CDE) and to compare the efficacies of thoracoscopy and traditional open surgery in infants with CDE. METHODS We retrospectively analyzed the clinical data of 125 children with CDE (90 boys, 35 girls; median age: 12.2 months, range: 1 h-7 years; body weight: 1.99-28.5 kg, median body weight: 7.87 ± 4.40 kg) admitted to our hospital in the previous 10 years, and we statistically analyzed their clinical manifestations and surgical methods. RESULTS A total of 108 children in this group underwent surgery, of whom 67 underwent open surgery and 41 underwent thoracoscopic diaphragmatic plication. A total of 107 patients recovered well postoperatively, except for 1 patient who died due to respiratory distress after surgery. After 1-9.5 years of follow-up, 107 patients had significantly improved preoperative symptoms. During follow-up, the location of the diaphragm was normal, and no paradoxical movement was observed. Eleven of the 17 children who did not undergo surgical treatment did not have a decrease in diaphragm position after 1-6 years of follow-up. The index data on the operation time, intraoperative blood loss, chest drainage time, postoperative mechanical ventilation time, postoperative hospital stay and postoperative CCU admission time were better in the thoracoscopy group than in the open group. The difference between the two groups was statistically significant (P < 0.05). CONCLUSIONS The clinical symptoms of congenital diaphragmatic eventration vary in severity. Patients with severe symptoms should undergo surgery. Both thoracoscopic diaphragmatic plication and traditional open surgery can effectively treat congenital diaphragmatic eventration, but compared with open surgery, thoracoscopic diaphragmatic plication has the advantages of a short operation time, less trauma, and a rapid recovery. Thus, thoracoscopic diaphragmatic plication should be the first choice for children with congenital diaphragmatic eventration.
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Affiliation(s)
- Shengliang Zhao
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, 400014, People's Republic of China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, People's Republic of China.,National Clinical Research Center for Child Health and Disorders (Chongqing), Chongqing, 400014, People's Republic of China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, 400014, People's Republic of China
| | - Zhengxia Pan
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, 400014, People's Republic of China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, People's Republic of China.,National Clinical Research Center for Child Health and Disorders (Chongqing), Chongqing, 400014, People's Republic of China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, 400014, People's Republic of China.,Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, People's Republic of China
| | - Yonggang Li
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, 400014, People's Republic of China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, People's Republic of China.,National Clinical Research Center for Child Health and Disorders (Chongqing), Chongqing, 400014, People's Republic of China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, 400014, People's Republic of China.,Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, People's Republic of China
| | - Yong An
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, 400014, People's Republic of China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, People's Republic of China.,National Clinical Research Center for Child Health and Disorders (Chongqing), Chongqing, 400014, People's Republic of China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, 400014, People's Republic of China.,Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, People's Republic of China
| | - Lu Zhao
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, 400014, People's Republic of China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, People's Republic of China.,National Clinical Research Center for Child Health and Disorders (Chongqing), Chongqing, 400014, People's Republic of China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, 400014, People's Republic of China
| | - Xin Jin
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, 400014, People's Republic of China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, People's Republic of China.,National Clinical Research Center for Child Health and Disorders (Chongqing), Chongqing, 400014, People's Republic of China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, 400014, People's Republic of China
| | - Jian Fu
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, 400014, People's Republic of China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, People's Republic of China.,National Clinical Research Center for Child Health and Disorders (Chongqing), Chongqing, 400014, People's Republic of China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, 400014, People's Republic of China
| | - Chun Wu
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, 400014, People's Republic of China. .,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, People's Republic of China. .,National Clinical Research Center for Child Health and Disorders (Chongqing), Chongqing, 400014, People's Republic of China. .,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, 400014, People's Republic of China. .,Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, People's Republic of China. .,, Room 806, Kejiao Building (NO. 6 Building), No. 136, 2nd Zhongshan Road, Yuzhong District, Chongqing, China.
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Eventration of right diaphragm with an intrathoracic ectopic kidney: A case report. Ann Med Surg (Lond) 2020; 57:179-182. [PMID: 32774850 PMCID: PMC7398964 DOI: 10.1016/j.amsu.2020.07.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/15/2020] [Accepted: 07/15/2020] [Indexed: 11/20/2022] Open
Abstract
Introduction Congenital diaphragmatic eventration is characterized by the elevation of the diaphragm, causing a protrusion of the intraabdominal viscera into the affected hemithorax and resulting in respiratory distress. Diaphragmatic eventration with an intrathoracic ectopic kidney is a very rare disorder with the incidence of 0.25% of all ectopias. Presentation of case A 16-day-old male presented with chief complaint of respiratory distress. His plain chest X-ray showed intestinal gases in the right diaphragm and elevation of the right diaphragm. Intraoperative findings revealed elevation of the right diaphragmatic dome and visceral displacement, including the ileum, transverse colon, and right lobe of the liver. Subsequently, hemidiaphragm plication was conducted. Two weeks after surgery, the patient suffered from respiratory distress again. Computed tomography (CT) scanning revealed right diaphragmatic elevation and an ectopic kidney inside the right hemithorax. During the second operation, there were no longer elevation of the right diaphragmatic dome nor any other organ displacement. Moreover, we decided to let the intrathoracic kidney remain in place. The outcome was good during the postoperative period and six months after surgery. Discussion Eventration of diaphragm with an intrathoracic ectopic kidney should be considered as a differential diagnosis in neonate patients with respiratory distress accompanied by a thoracic mass. Conclusion Congenital diaphragmatic eventration with an intrathoracic ectopic kidney is a very rare disorder, requiring a personalized surgical repair to achieve a good outcome. CT scanning may help confirm the diagnosis, particularly to define the dome elevation and the intrathoracic organ precisely. CT-scan should be performed to establish the diagnosis of eventration of diaphragm and to find an incidental, very rare intrathoracic finding, such as an ectopic kidney. Diaphragmatic eventration with an intrathoracic ectopic kidney is a very rare disorder, requiring personalized surgical repair to achieve a good outcome. Ectopic kidney might be left intrathoracic without any complications and not require any surgical treatment.
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Thoracic versus abdominal approach to correct diaphragmatic eventration in children. J Pediatr Surg 2020; 55:245-248. [PMID: 31761454 DOI: 10.1016/j.jpedsurg.2019.10.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 10/26/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Plication of diaphragm (DP) for eventration (DE) can be done using thoracic or abdominal approaches. The purpose of our study was to compare outcomes between these approaches based on our experience and on systematic literature review. METHODS Retrospective records of children <16 years who underwent DP (single-center, 2004-2018) were recorded and analyzed. Systematic review and meta-analysis of related studies was undertaken. Data are reported as median (range). RESULTS Eighty-nine cases were identified in thoracic (Congenital = 5, Acquired = 84) and 13 (Congenital = 10, Acquired = 3) in abdominal group aged 5.88 (0.36-184.44) and 10.0 (0.12-181.8) months. Improvement in diaphragm level post-DP was significantly higher in abdominal [2(0-4)] than chest [1.5(0-5)] group (p = 0.04). On Cox regression analysis, there was a non-significant trend to a longer time to extubation in the chest group (Hazard ratio (HR) = 0.539[0.208-1.395], p = 0.203). Patients operated transthoracically left intensive care unit after a significantly longer time (HR = 0.339[0.119-0.966], p = 0.043). Patients operated transabdominally tended to be fed later, although this was not significant (HR = 1.801[0.762-4.253], p = 0.043). On Kaplan-Meier analysis, there was a non-significant trend to a lower rate of recurrence in the abdominal group (HR = 0.3196[0.061-1.675], p = 0.1876). In the meta-analysis including three published studies as well as our data (total n = 181, Thoracic = 139, Abdominal = 42), no difference was found in the incidence of recurrence amongst the 2 groups (RD = -0.04, 95%CI = -0.25, 0.18, p = 0.74). CONCLUSION This is one of the largest reports on outcomes of children undergoing DP for DE. There is no significant difference in recurrence rate, even though all recurrences in our series (15.7%) were in the acquired cases operated using a thoracic approach. TYPE OF STUDY Treatment Retrospective Comparative Study. LEVEL OF EVIDENCE Level III.
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6
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van der Linden V, Lins OG, de Lima Petribu NC, de Melo ACMG, Moore J, Rasmussen SA, Moore CA. Diaphragmatic paralysis: Evaluation in infants with congenital Zika syndrome. Birth Defects Res 2019; 111:1577-1583. [PMID: 31595718 DOI: 10.1002/bdr2.1597] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/13/2019] [Accepted: 09/13/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Paralysis of the diaphragm in newborn infants can lead to recurrent infections and life-threatening respiratory insufficiency. The clinical diagnosis of unilateral diaphragmatic paralysis has been reported in infants with laboratory evidence of congenital Zika virus infection and/or the congenital Zika syndrome (CZS) phenotype but no evaluation of phrenic nerve function has been described. All reported infants have had accompanying arthrogryposis. High infant mortality is reported. METHODS The causal mechanism of congenital diaphragmatic paralysis was evaluated in three infants with arthrogryposis as a manifestation of CZS (two of the three infants had laboratory evidence of ZIKV infection shortly after birth; the remaining infant had negative serology for ZIKV when first tested at 7 months of age). Electromyography and phrenic nerve compound muscle action potential (CMAP) were performed in all infants with diaphragmatic paralysis demonstrated on imaging studies. RESULTS All infants had evidence of moderate chronic involvement of peripheral motor neurons. Phrenic nerve CMAP was reduced on the side of the diaphragmatic paralysis in two infants and reduced bilaterally in the remaining infant who had primarily anterior involvement of the diaphragm. All three infants had multiple medical complications and one infant died at 18 months of age. CONCLUSION Evaluation of three infants with CZS and diaphragmatic paralysis demonstrated phrenic nerve dysfunction. In these and other affected infants, arthrogryposis appears to be a constant co-occurring condition and health problems are significant; both conditions are likely due to involvement of the peripheral nervous system in some infants with CZS.
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Affiliation(s)
- Vanessa van der Linden
- Association for Assistance of Disabled Children, Recife, Brazil.,Barāo de Lucena Hospital, Recife, Brazil
| | | | | | | | - Jazmyn Moore
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sonja A Rasmussen
- College of Medicine, Department of Pediatrics, University of Florida, Gainesville, Florida.,College of Medicine and College of Public Health and Health Professions, Department of Epidemiology, University of Florida, Gainesville, Florida
| | - Cynthia A Moore
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
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Lameh A, Seyedi SJ, Farrokh D, Lavasani S, Alamdaran SA. Diagnostic Value of Ultrasound in Detecting Causes of Pediatric Chest X-Ray Opacity. Turk Thorac J 2019; 20:175-181. [PMID: 30986176 PMCID: PMC6590271 DOI: 10.5152/turkthoracj.2018.18087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 10/18/2018] [Indexed: 12/30/2023]
Abstract
OBJECTIVES Computed tomography is considered as the diagnostic gold standard for following up the majority of pediatric chest X-ray (CXR) opacities. However, radiation, cost, and waiting times have led to search for diagnostic alternatives. This study was conducted to determine the diagnostic accuracy of the ultrasound (US) in detecting the causes of pediatric CXR opacities. MATERIALS AND METHODS This study was conducted on the pediatric patients with CXR opacity referring to Dr. Sheikh Hospital in Mashhad, Iran during 2016-2017. After undergoing the US exam, the patients were followed to obtain the final diagnosis based on reference standard (RF). The accuracy of the US was calculated in detection of thoracic lesions. P value <0.05 was considered to be significant. RESULTS The most common diagnostic cause of CXR opacity based on RF was pneumonia (n=46, 35-38%), thymus (n=37, 28-46%), bone and soft tissue mass (n=12, 9.23%), cystic lesions (n=11, 8.46%), and diaphragmatic lesions (n=10, 7.69%), as well as intrathoracic masses and empyema (n=7, 5.38%). In only four patients (3.07%), the final diagnosis based on RF was inconsistent with the US diagnosis. The diagnostic accuracy of the US was 100% in the diagnosis of bone and soft tissue masses, diaphragmatic lesions, empyema, and normal thymus, and the accuracy was 96.92% for pneumonia, and 99.23% for cystic lesions and intrathoracic masses. CONCLUSION Regarding the assessed diagnostic accuracy, the US can be a reliable diagnostic tool to differentiate the main cause of pediatric CXR opacity.
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Affiliation(s)
- Ahmadreza Lameh
- Department of Radiology, Mashhad University of Medical Sciences, School of Medicine, Mashhad, Iran
| | - Seyed Javad Seyedi
- Department of Pediatrics, Mashhad University of Medical Sciences, School of Medicine, Mashhad, Iran
| | - Donia Farrokh
- Department of Radiology, Mashhad University of Medical Sciences, School of Medicine, Mashhad, Iran
| | - Somayehsadat Lavasani
- Department of Oral and Maxillofacial Radiology, Birjand University of Medical Sciences, School of Medicine, Birjand, Iran
| | - Seyed Ali Alamdaran
- Department of Radiology, Mashhad University of Medical Sciences, School of Medicine, Mashhad, Iran
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Taşcı Hİ. Sigmoid volvulus sonrası tanı konulan diyafram evantrasyonu ve çoklu organ anomali birlikteliği. CUKUROVA MEDICAL JOURNAL 2019. [DOI: 10.17826/cumj.440236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Kang H, Lee S, Park H, Kim Y, Ko Y, Kim YH, Hong B. Ultrasound-guided perioperative management of 28-month-old patient with congenital diaphragmatic eventration. SAGE Open Med Case Rep 2019; 7:2050313X19827737. [PMID: 30800303 PMCID: PMC6378513 DOI: 10.1177/2050313x19827737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 01/10/2019] [Indexed: 11/29/2022] Open
Abstract
Diaphragmatic eventration is a rare anomaly. When patients with this condition undergo general anesthesia, anesthetic management should be performed with particular care owing to the risk of diaphragmatic rupture. Such a rupture can be perioperatively diagnosed using multiple tools including lung ultrasonography. This case report describes the anesthetic management of a male infant with osteochondroma in the distal ulna, presenting with diaphragmatic eventration on the right side.
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Affiliation(s)
- Hyemin Kang
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Sangmin Lee
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Hyunwoo Park
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Yeojung Kim
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - YoungKwon Ko
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea.,Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Yoon-Hee Kim
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea.,Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Boohwi Hong
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea.,Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
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10
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Right Diaphragmatic Eventration with an Intrathoracic Kidney: Case Report and Review of the Literature. Case Rep Surg 2018; 2018:2631391. [PMID: 30631630 PMCID: PMC6304889 DOI: 10.1155/2018/2631391] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 11/25/2018] [Indexed: 11/17/2022] Open
Abstract
We aimed to review the publications on the diagnosis of diaphragmatic eventration and report on the clinical presentation and surgical treatment of a female patient aged 17 years. The present case, though quite infrequent, shows the presence of an ectopic thoracic kidney on the right side. The clinical features included dry cough, chest pain, respiratory distress, and bronchial spasms for 4 years; additionally, the patient had episodes of bronchial asthma since her childhood. The right hemithorax presented invasion of the thin loops, right colon, and kidney. The treatment approach was laparoscopic followed by thoracotomy using a dual mesh. The intrathoracic kidney remained in place. The outcome was satisfactory. Diaphragmatic eventration associated with thoracic renal ectopia is a very rare entity, considering the age, sex, and right location of the condition. It represents a clinical and diagnostic challenge; clinicians, radiologists, and surgeons must be alert with a high degree of suspicion in order to correlate symptoms and imaging findings and understand the etiopathogenesis. In addition, they should plan an adequate and individualized surgical repair making use, as far as possible, of the minimally invasive procedures that are currently used.
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11
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Is surgical plication necessary in diaphragm eventration? Asian J Surg 2017; 39:59-65. [PMID: 26117205 DOI: 10.1016/j.asjsur.2015.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 04/23/2015] [Accepted: 05/06/2015] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Diaphragm plication surgery is conducted to remove dyspnea, which results from mediastinal shift, atelectasia, and ventilation/perfusion dyssynchrony in lungs that occur because of an eventrated diaphragm. This study aims to determine whether diaphragm plication has any effect on respiration by analyzing the patients' changing values in the respiratory function test (RFT) after plication surgery. METHODS Sixteen patients who underwent diaphragm plication surgery in our clinic because of plication eventration or paralysis were examined prospectively. Diaphragm eventration values were assessed using a calculation method that uses posteroanterior pulmonary radiographies taken during patient admission and control; then, these data were recorded. The amount of changes in the eventration levels and in restrictive respiratory failure parameters-forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC) of RFTs-conducted in pre- and postoperative control periods were compared using statistical analysis methods. The compatibility between the amounts of RFT changes was examined through a satisfaction survey-using a questionnaire that consisted of multiple choice questions with answer options such as "better," "the same," and "worse"-to understand preoperative and postoperative symptom levels in the 12(th) month of postoperative control. RESULTS According to postoperative levels, a decrease between 19% and 23% was observed in eventration amounts within the 1(st) postoperative month, 6(th) postoperative month, and 12(th) postoperative month. In addition, the highest average increase in FEV1 liter (lt) values was 0.2 lt and 0.25 in FVC (lt) values. CONCLUSION Researchers of this study believe that more distinctive decisions need to be taken while identifying patients for surgery in unilateral diaphragm eventrations, especially in the adult patient group; surgical option should be used for cases in which the eventrated diaphragm results in mediastinal shift and respiratory failure.
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12
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Sun J, McGillivray AJ, Pinner J, Yan Z, Liu F, Bratkovic D, Thompson E, Wei X, Jiang H, Asan, Chopra M. Diaphragmatic Eventration in Sisters with Asparagine Synthetase Deficiency: A Novel Homozygous ASNS Mutation and Expanded Phenotype. JIMD Rep 2016; 34:1-9. [PMID: 27469131 DOI: 10.1007/8904_2016_3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 06/14/2016] [Accepted: 06/15/2016] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Asparagine Synthetase Deficiency (ASNSD; OMIM #615574) is a newly described rare autosomal recessive neurometabolic disorder, characterised by congenital microcephaly, severe psychomotor delay, encephalopathy and progressive cerebral atrophy. To date, seven families and seven missense mutations in the ASNSD disease causing gene, ASNS, have been published. METHODS We report two further affected infant sisters from a consanguineous Indian family, who in addition to the previously described features had diaphragmatic eventration. Both girls died within the first 6 months of life. Whole exome sequencing (WES) was performed for both sisters to identify the pathogenic mutation. The clinical and biochemical parameters of our patient are compared to previous reports. RESULTS WES demonstrated a homozygous novel missense ASNS mutation, c.1019G > A, resulting in substitution of the highly conserved arginine residue by histidine (R340H). CONCLUSION This report expands the phenotypic and mutation spectrum of ASNSD, which should be considered in neonates with congenital microcephaly, seizures and profound neurodevelopmental delay. The presence of diaphragmatic eventration suggests extracranial involvement of the central nervous system in a disorder that was previously thought to exclusively affect the brain. Like all previously reported patients, these cases were diagnosed with WES, highlighting the clinical utility of next generation sequencing in the diagnosis of rare, difficult to recognise disorders.
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Affiliation(s)
- Jun Sun
- Binhai Genomics Institute, BGI-Tianjin, BGI-Shenzhen, Tianjin, 300308, China.,Tianjin Enterprise Key Laboratory of Clinical molecular diagnostic, BGI-Shenzhen, Tianjin, 300308, China.,BGI-Shenzhen, Shenzhen, 518083, China
| | - Angela J McGillivray
- Department of Newborn Care, Royal Prince Alfred Hospital, Missenden Road, Camperdown, 2050, Sydney, NSW, Australia
| | - Jason Pinner
- Department of Medical Genomics, Royal Prince Alfred Hospital, Missenden Road, Camperdown, 2050, Sydney, NSW, Australia
| | - Zhihui Yan
- Key Laboratory of Systems Microbial Biotechnology, Tianjin Institute of Industrial Biotechnology, Chinese Academy of Sciences, Tianjin, 300308, China
| | - Fengxia Liu
- Binhai Genomics Institute, BGI-Tianjin, BGI-Shenzhen, Tianjin, 300308, China.,Tianjin Enterprise Key Laboratory of Clinical molecular diagnostic, BGI-Shenzhen, Tianjin, 300308, China.,BGI-Shenzhen, Shenzhen, 518083, China
| | - Drago Bratkovic
- Metabolic Clinic, South Australian Clinical Genetics Service, SA Pathology, 5000, Adelaide, SA, Australia
| | - Elizabeth Thompson
- Department of Radiology, Royal Prince Alfred Hospital, Missenden Road, Camperdown, Sydney, 2050, NSW, Australia
| | - Xiuxiu Wei
- Binhai Genomics Institute, BGI-Tianjin, BGI-Shenzhen, Tianjin, 300308, China.,Tianjin Enterprise Key Laboratory of Clinical molecular diagnostic, BGI-Shenzhen, Tianjin, 300308, China.,BGI-Shenzhen, Shenzhen, 518083, China
| | - Huifeng Jiang
- Key Laboratory of Systems Microbial Biotechnology, Tianjin Institute of Industrial Biotechnology, Chinese Academy of Sciences, Tianjin, 300308, China
| | - Asan
- Binhai Genomics Institute, BGI-Tianjin, BGI-Shenzhen, Tianjin, 300308, China. .,Tianjin Enterprise Key Laboratory of Clinical molecular diagnostic, BGI-Shenzhen, Tianjin, 300308, China. .,BGI-Shenzhen, Shenzhen, 518083, China.
| | - Maya Chopra
- Department of Medical Genomics, Royal Prince Alfred Hospital, Missenden Road, Camperdown, 2050, Sydney, NSW, Australia. .,Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China. .,Discipline of Genetic Medicine, University of Sydney, Sydney, 2050, NSW, Australia.
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13
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Kim J, Kim S, Jo J, Lee S, Eom K. Radiographic and computed tomographic features of caval foramen hernias of the liver in 7 dogs: mimicking lung nodules. J Vet Med Sci 2016; 78:1693-1697. [PMID: 27430293 PMCID: PMC5138423 DOI: 10.1292/jvms.16-0161] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This study describes the imaging features and characteristics of caval foramen hernias in
7 dogs diagnosed by computed tomography (CT). On lateral radiographs, 6 of 7 dogs showed
dome-shaped, broad-based, caudal mediastinal lesions. CT findings included caudal vena
cava (CVC) compression (n=7), right lateral (n=6) or
medial (n=1) liver lobe involvement, hepatic vein dilation
(n=5) and biliary tract involvement (n=1) with partial
(n=6) or entire (n=1) liver lobe hernias. A caval
foramen hernia should be part of the differential diagnosis when the aforementioned
imaging features are detected. CT is considered as a useful tool for diagnosis and
evaluation in dogs with a caval foramen hernia.
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Affiliation(s)
- Jaehwan Kim
- Konkuk University, 120, Neungdong-ro, Gwangjin-gu, Seoul, Korea
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14
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Alshorbagy A, Mubarak Y. Open Transthoracic Plication of the Diaphragm for Unilateral Diaphragmatic Eventration in Infants and Children. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2015; 48:307-10. [PMID: 26509123 PMCID: PMC4622030 DOI: 10.5090/kjtcs.2015.48.5.307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 07/28/2015] [Accepted: 08/14/2015] [Indexed: 11/16/2022]
Abstract
Background To evaluate our experience of early surgical plication for diaphragmatic eventration (DE) in infancy and childhood. Methods This study evaluated infants and children with symptomatic DE who underwent plication through an open transthoracic approach in our childhood development department between January 2005 and December 2012. Surgical plication was performed in several rows using polypropylene U-stitches with Teflon pledgets. Results The study included 12 infants and children (7 boys and 5 girls) with symptomatic DE (9 congenital and 3 acquired). Reported symptoms included respiratory distress (91.7%), wheezing (75%), cough (66.7%), and recurrent pneumonia (50%). Preoperative mechanical ventilatory support was required in 41.7% of the patients. The mean length of hospital stay was 6.3±2.5 days. The mean follow-up period was 24.3±14.5 months. Preoperative symptoms were immediately relieved after surgery in 83.3% of patients and persisted in 16.7% of patients one year after surgery. All patients survived to the end of the two-year follow-up and none had recurrence of DE. Conclusion Early diagnosis and surgical plication of the diaphragm for symptomatic congenital or acquired diaphragmatic eventration offers a good clinical outcome with no recurrence.
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Affiliation(s)
| | - Yasser Mubarak
- Cardiothoracic Surgery Department, Minia University Hospital
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15
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Wu S, Zang N, Zhu J, Pan Z, Wu C. Congenital diaphragmatic eventration in children: 12 years' experience with 177 cases in a single institution. J Pediatr Surg 2015; 50:1088-92. [PMID: 25783408 DOI: 10.1016/j.jpedsurg.2014.09.055] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 08/13/2014] [Accepted: 09/03/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE This study sought to summarize the diagnostic and treatment aspects of congenital diaphragmatic eventration (CDE) in children by retrospectively analyzing their medical records to identify and understand the complications of CDE, its treatment, and to evaluate the long-term outcomes of diaphragmatic plication. METHODS The medical records of children who received treatment for CDE from January 2000 to December 2011 at the Children's Hospital of Chongqing Medical University, China were analyzed. Data analyzed included the following: age, sex, symptom, location of eventration, associated anomalies, surgical procedures, complications, and survival and follow up details after diaphragmatic plication. RESULTS The medical records of 177 children (boys: 128, girls: 49, mean age: 10.28±2.35 months) with CDE were included in this study. Specific symptoms of eventration of the diaphragm were reported for 86 cases; and the typical symptoms included rapid breathing, vomiting, and recurrent respiratory infections. Except for a bilateral case, all the other patients had unilateral CDE. Associated malformations were observed in 31 cases (17.5%), hypoplastic lung (10 cases) was the most common followed by congenital heart disease (9 cases), and cryptorchidism (3 cases). Interestingly, 91 patients were asymptomatic. Diaphragmatic plication was performed in all symptomatic patients (86 cases, 48.5%) and none had recurrence. CONCLUSIONS Clinical symptoms of CDE varied in severity, ranging from asymptomatic conditions to life-threatening respiratory distress. Timely accurate diagnosis and treatment of symptomatic CDE could effectively resolve respiratory morbidity and reduce complications. The diaphragm plication surgery provided good results among the study population with no recurrence.
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Affiliation(s)
- Shengde Wu
- Ministry of Education Key Laboratory of Child Development and Disorders; Key Laboratory of Pediatrics in Chongqing, CSTC2009CA5002; Chongqing International Science and Technology Cooperation Center for Child Development and Disorders; Department of Pediatric Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Na Zang
- Ministry of Education Key Laboratory of Child Development and Disorders; Key Laboratory of Pediatrics in Chongqing, CSTC2009CA5002; Chongqing International Science and Technology Cooperation Center for Child Development and Disorders; Department of Respiratory Medicine, Children's Hospital, Chongqing Medical University
| | - Jin Zhu
- Ministry of Education Key Laboratory of Child Development and Disorders; Key Laboratory of Pediatrics in Chongqing, CSTC2009CA5002; Chongqing International Science and Technology Cooperation Center for Child Development and Disorders; Department of Pathology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Zhengxia Pan
- Ministry of Education Key Laboratory of Child Development and Disorders; Key Laboratory of Pediatrics in Chongqing, CSTC2009CA5002; Chongqing International Science and Technology Cooperation Center for Child Development and Disorders; Department of Pediatric Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Chun Wu
- Ministry of Education Key Laboratory of Child Development and Disorders; Key Laboratory of Pediatrics in Chongqing, CSTC2009CA5002; Chongqing International Science and Technology Cooperation Center for Child Development and Disorders; Department of Pediatric Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
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16
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Eventration of diaphragm presenting as recurrent respiratory tract infections – A case report. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2015. [DOI: 10.1016/j.ejcdt.2014.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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17
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Thoracoscopic and laparoscopic plication of the hemidiaphragm is effective in the management of diaphragmatic eventration. Pediatr Surg Int 2014; 30:19-24. [PMID: 24100524 DOI: 10.1007/s00383-013-3418-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Diaphragmatic plication by minimally invasive surgery is thought to allow for a quick recovery and has been performed on small children. Here, we report our experience with different plication procedures to discuss how to choose among these different plication procedures in endoscopic surgery for pediatric patients with diaphragmatic eventration. PATIENTS AND METHODS We retrospectively analyzed clinical data of 27 pediatric patients (21 boys, 6 girls; median age: 12.7 months, range 2 months-3 years) admitted to our hospital between November 2008 and July 2013. Three different plication procedures were used: the "reefing the mainsail" technique (8 patients), "invaginating the diaphragmatic dome" technique (10 patients), and "pleating" technique (9 patients). Indications included ventilator dependency (7.41 %), respiratory distress (22.22 %), chronic lung lobe collapse (11.11 %), persistent atelectasis with recurrent pneumonias (18.52 %), and asymptomatic severe eventration (40.74 %). RESULTS Descending distance of diaphragm after surgery ranged from 1 to 4.5 intercostal spaces (mean distance: 2.65 intercostal spaces). All patients recovered well postoperatively, except for one patient with a pneumothorax. Two patients who required respiratory support before the operation no longer required it within 7 d after surgery. Follow-up ranged from 1 to 35 months. Clinical results were satisfactory with obvious improvement in symptoms and a slight re-elevation within a distance of one intercostal space. CONCLUSION For pediatric patients with diaphragmatic eventration, different endoscopic surgeries and plication procedures all yielded satisfactory results. We believe that the choice of one procedure over the other depends only on the surgeon's experience.
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18
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Shivanna S, Tejesh C, Manjunath A, Sandhya K. Sciaticofemoral nerve block for varicose vein surgery in the patient with eventration of diaphragm, dextroposition of the heart and bicuspid aortic valve. J Anaesthesiol Clin Pharmacol 2012; 28:277-9. [PMID: 22557773 PMCID: PMC3339755 DOI: 10.4103/0970-9185.94933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Shivakumar Shivanna
- Department of Anaesthesiology, MS Ramaiah Medical College, Bangalore, Karnataka, India
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19
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Transient elevation of the ipsilateral hemidiaphragm associated with pneumonia. Can Respir J 2011; 18:e66-7. [PMID: 22059187 DOI: 10.1155/2011/454052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Seventeen children with lobar or segmental pneumonia and ispilateral elevation of the diaphragm are described. These children did not differ significantly with respect to clinical and laboratory findings from their counterparts with pneumonia but without elevation of the hemidiaphragm. The elevation was transient and resolved by the time the repeat chest x-ray was taken six to eight weeks later.
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20
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Sandstrom CK, Stern EJ. Diaphragmatic hernias: a spectrum of radiographic appearances. Curr Probl Diagn Radiol 2011; 40:95-115. [PMID: 21440192 DOI: 10.1067/j.cpradiol.2009.11.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Diaphragmatic hernias are common, and although frequently incidental, recognition of both benign and life-threatening manifestations of diaphragmatic hernias is necessary to guide appropriate management. Congenital fetal diaphragmatic hernias, traumatic diaphragmatic rupture, and large symptomatic Bochdalek, Morgagni, and hiatal hernias are typically repaired surgically, while eventration, diaphragmatic slips, and small diaphragmatic hernias do not require intervention or imaging follow-up but should be recognized to avoid confusion with other diagnoses that require additional attention. This pictorial essay will explore the imaging findings and clinical characteristics of these entities.
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Affiliation(s)
- Claire K Sandstrom
- Division of Chest Imaging, Department of Radiology, University of Washington, Seattle, WA 98195-7115, USA.
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CHOI JIHYE, KIM HYUNWOOK, KIM MIEUN, YOON JUNGHEE. IMAGING DIAGNOSIS-POSITIVE CONTRAST PERITONEOGRAPHIC FEATURES OF TRUE DIAPHRAGMATIC HERNIA. Vet Radiol Ultrasound 2009; 50:185-7. [DOI: 10.1111/j.1740-8261.2009.01514.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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22
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Kabiri EH, Zidane A, Arsalane A, Atoini F. Right diaphragmatic eventration associated with dextrocardia, hypoplasia of the right lower pulmonary lobe, and agenesis of the inferior vena cava. J Thorac Cardiovasc Surg 2007; 133:1380-1. [PMID: 17467469 DOI: 10.1016/j.jtcvs.2006.12.054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2006] [Accepted: 12/12/2006] [Indexed: 11/21/2022]
Affiliation(s)
- El Hassane Kabiri
- Department of Thoracic Surgery, Mohamed V Military Teaching Hospital, Rabat, Morocco.
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23
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Giannini A, Pinto AM, Rossetti G, Prandi E, Tiziano D, Brahe C, Nardocci N. Respiratory failure in infants due to spinal muscular atrophy with respiratory distress type 1. Intensive Care Med 2006; 32:1851-5. [PMID: 16964485 DOI: 10.1007/s00134-006-0346-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2006] [Accepted: 07/24/2006] [Indexed: 02/05/2023]
Abstract
BACKGROUND Spinal muscular atrophy with respiratory distress type 1 (SMARD1) is a rare autosomal recessive neuromuscular disease of unknown prevalence characterized by degeneration of anterior horn alpha-motoneurons and manifesting in the first 6months of life as life-threatening irreversible diaphragmatic paralysis associated with progressive symmetrical muscular weakness (distal lower limbs mainly involved), muscle atrophy, and peripheral sensory neuropathy. SETTING Pediatric intensive care unit of tertiary care hospital. PATIENTS We present two new cases of SMARD1 and report two new mutations in the gene IGHMBP2 which encodes immunoglobulin mu-binding protein 2 on chromosome 11q13. CONCLUSIONS SMARD1 is a poor-prognosis disease that should be considered when acute respiratory insufficiency, of suspected neuromuscular or unclear cause, develops during the first 6months of life. Diaphragmatic paralysis, manifesting as dyspnea and paradoxical respiration, is the most prominent presenting sign and diaphragmatic motility should be investigated early by fluoroscopy or ultrasound. Electromyography and nerve conduction studies revealing peripheral motor and sensory neuropathy then suggest the diagnosis which should be confirmed by genetic analysis.
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Affiliation(s)
- Alberto Giannini
- Pediatric Intensive Care Unit, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Via della Commenda 9, 20122, Milan, Italy.
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