Thoracoscopic repair of a large neonatal congenital diaphragmatic hernia using Gerota's fascia

Surgical management of the diaphragmatic defect in congenital diaphragmatic hernia: a contemporary review

Worldwide, 150 children are born each day with congenital diaphragmatic hernia (CDH), a diaphragmatic defect with concomitant abnormal lung development. Patients with CDH with large defects are particularly challenging to treat, have the highest mortality, and are at significant risk of long-term complications. Advances in prenatal and neonatal treatments have improved survival in high-risk patients with CDH, but surgical treatment of large defects lacks standardization. Open repair by an abdominal approach has long been considered the traditional procedure, but the type of defect repair (patch or muscle flap) and patch material (non-absorbable, synthetic or absorbable, biological) remain subjects of debate. Increased experience and improved techniques in minimally invasive surgery (MIS) have expanded selection criteria for thoracoscopic defect repair in cardiopulmonary stable patients with small defects. However, the application of MIS to repair large defects remains controversial due to increased recurrence rates and unknown long-term effects of perioperative hypercapnia and acidosis resulting from capnothorax and reduced ventilation. Current recommendations on the surgical management rely on cohort studies of varying patient numbers and data on the long-term outcomes are sparse. Here, we discuss surgical approaches for diaphragmatic defect repair highlighting advancements, and knowledge gaps in surgical techniques (open surgery and MIS), patch materials and muscle flaps for large defects, as well as procedural adjuncts and management of CDH variants.

A sculpture masterpiece for the teaching of anatomy

Background and aim

The study of anatomy remains the backbone of medical education in the first years. There is a constant need for educational materials that enable the assimilation of knowledge by students. The casts after human bodies have not lost the value, even in the era of virtual education. We present in this paper a museal item destined to improve the anatomy teaching.

Methods

Given the existence in the department of anatomy from Cluj –Napoca of an item of exceptional artistic and scientific value, we intensively searched Pubmed and Scopus, as well as by manual search of printed only documents, for all papers related to the muscle man by Brancusi created for educational purposes of anatomy students.

Results

This paper presents summary data from the biography of the creators of this item, the world famous sculptor Constantin Brancusi and the professor of anatomy and surgery from Bucharest Dimitrie Gerota. We also describe this item and the conditions which generated it

Conclusion

Teaching anatomy relies on the quality of the didactic support. The muscle man by Brancusi is a very realistic reproduction of a man, very useful for anatomical training and teaching.