• Advances in pediatric surgery
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• v.17 no.2
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• pp.133-138
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• 2011

Extracorporeal membrane oxygenation (ECMO) has been utilized in congenital diaphragmatic hernia (CDH) patients with severe respiratory failure unresponsive to conventional medical treatment. We retrospectively reviewed 12 CDH patients who were treated using ECMO in our center between April 2008 and February 2011. The pre ECMO and on ECMO variables analyzed included gestational age, sex, birth weight, age at the time of ECMO cannulation, arterial blood gas analysis results, CDH location, timing of CDH repair operation, complications and survival. There were 9 boys and 3 girls. All patients were prenatally diagnosed. Mean gestational age was $38.8{\pm}1.7$ weeks and mean birth weight was $3031{\pm}499$ gram. Mean age at the time of ECMO cannulation was $29.9{\pm}28.9$ hours. There were 4 patients who survived. Survivors showed higher 5 min Apgar scores ($8.25{\pm}0.96$ vs. $7.00{\pm}1.20$, p=0.109), higher pre ECMO mean pH ($7.258 {\pm}0.830$ vs. $7.159{\pm}0.986$, p=0.073) and lower pre ECMO $PaCO_2$ ($48.2{\pm}7.9$ vs. $64.8{\pm}16.1$, p=0.109) without statistical significance. The hernia was located on the left side in 10 patients and the right side in 2 patients. The time interval from ECMO placement to operative repair was about 3~4 days in 5 early cases and around 24 in the remaining cases. There were 3 cases of post operative bleeding requiring re operation and 2 cases of abdominal compartment syndrome requiring abdominal fascia reopening. ECMO catheter reposition was required in 4 cases. Three cases of arterial or venous thrombosis were detected and improved with follow up. Our data suggests that ECMO therapy could save the lives of some neonates with CDH who can not be maintained on other treatment modalities. Protocolized management and accumulation of case experience might be valuable in improving outcomes for neonates with CDH treated with ECMO.

• Childhood Kidney Diseases
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• v.13 no.1
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• pp.84-91
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• 2009

We experienced a female neonate with congenital nephrotic syndrome (CNS) associated with congenital diaphragmatic hernia (CDH). Because of the rare combination of two conditions, we report this case with literature review. CDH was found immediately after birth and emergency operation was done for hernia repair. But on the next day, generalized edema and oliguria(0.59 mL/kg/hour) was found and her blood chemistry showed hypoalbuminemia (1.6 g/dL), increased BUN (27.7 mg/dL) and serum creatinine( 1.8 mg/dL) along with heavy proteinuria (4+). We started albumin infusion with a bolus of intravenous furosemide. We suspected the neonate had congenital nephrotic syndrome and her 24hr urine protein was 1,816 mg/day. In spite of immunosuppressive therapy, the nephrotic syndrome and renal failure progressed. We started peritoneal dialysis on the day of life 22 but it was not satisfactory. She was complicated by intracranial hemorrhage and multi-organ failure and expired at 34 days of age. Kidney necropsy was performed which showed diffuse mesangial sclerosis (DMS). Her chromosome study revealed 46, XX and her gene study revealed a heterozygous missense mutation, Arg366His, in Wilms tumor suppressor gene (WT1). This case deserves attention on account of the 4th case of CNS with CDH revealing the Arg366His mutation in the WT1 gene and G the 1st case of early onset renal failure without male pseudohermaphroditism and Wilms tumor with CNS, CDH and the Arg366His mutation in the WT1 gene. So, this report gives support to the hypothesis that Arg366His mutation in the WT1 gene can result in CNS and CDH.

• Journal of Chest Surgery
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• v.40 no.10
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• pp.722-725
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• 2007

Morgagni's hernia constitutes about 3% of all the congenital diaphragm hernias. It is usually asymptomatic and it is frequently found coincidentally during routine diagnostic testing in adulthood. It is usually diagnosed by simple chest X-ray, but when this condition is without intestinal herniation, then chest CT or other modalities are necessary. Operative repair is desirable when there is the risk of strangulation of the intestine. The trans-thoracic or trans-abdominal approaches are possible to treat this malady. We report here on one case for which we successfully used a laparoscopic approach to treat this problem.

• Journal of Chest Surgery
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• v.54 no.5
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• pp.348-355
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• 2021

Background: Congenital diaphragmatic hernia (CDH) is a rare disease often requiring mechanical ventilation after birth. In severe cases, extracorporeal membrane oxygenation (ECMO) may be needed. This study analyzed the outcomes of patients with CDH treated with ECMO and investigated factors related to in-hospital mortality. Methods: Among 254 newborns diagnosed with CDH between 2008 and 2020, 51 patients needed ECMO support. At Asan Medical Center, a multidisciplinary team approach has been applied for managing newborns with CDH since 2018. Outcomes were compared between hospital survivors and nonsurvivors. Results: ECMO was established at a median of 17 hours after birth. The mean birth weight was 3.1±0.5 kg. Twenty-three patients (23/51, 45.1%) were weaned from ECMO, and 16 patients (16/51, 31.4%) survived to discharge. The ECMO mode was veno-venous in 24 patients (47.1%) and veno-arterial in 27 patients (52.9%). Most cannulations (50/51, 98%) were accomplished through a transverse cervical incision. No significant between-group differences in baseline characteristics and prenatal indices were observed. The oxygenation index (1 hour before: 90.0 vs. 51.0, p=0.005) and blood lactate level (peak: 7.9 vs. 5.2 mmol/L, p=0.023) before ECMO were higher in nonsurvivors. Major bleeding during ECMO more frequently occurred in nonsurvivors (57.1% vs. 12.5%, p=0.007). In the multivariate analysis, the oxygenation index measured at 1 hour before ECMO initiation was identified as a significant risk factor for in-hospital mortality (odds ratio, 1.02; 95% confidence interval, 1.01-1.04; p=0.05). Conclusion: The survival of neonates after ECMO for CDH is suboptimal. Timely application of ECMO is crucial for better survival outcomes.

• Journal of Chest Surgery
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• v.56 no.3
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• pp.171-176
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• 2023

Background: This study analyzed and described the clinical characteristics and surgical outcomes of diaphragmatic hernia (DH) repair according to the operative approach. Methods: After excluding cases with a combined approach and hiatal hernias, we analyzed 26 patients who underwent DH repair between 1994 and 2018. The baseline and perioperative characteristics of the thoracic approach group and the abdominal approach group were described and analyzed. Results: Fifteen of the 26 patients were treated through the thoracic approach, including 5 patients who underwent video-assisted thoracic surgery (VATS). Eleven patients underwent the abdominal approach. The thoracic approach was associated with a longer duration of DH than the abdominal approach (2 vs. 0.1 months), herniation of the right-sided abdominal organs, and herniation of the retroperitoneal organs. During the median follow-up of 23 months, there was no recurrence of DH. Conclusion: The surgical approach should be chosen considering the duration of DH and the location of herniated organs. VATS might be a safe and feasible option for repairing DH.

• Advances in pediatric surgery
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• v.12 no.2
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• pp.192-201
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• 2006

There are considerable controversies in the management of congenital diaphragmatic hernia. By 1997, early operation, routine chest tube on the ipsilateral side and maintainingrespiratory alkalosis by hyperventilation were our principles (period I). With a transition period from 1998 to 1999, delayed operation with sufficient resuscitation, without routine chest tube, and permissive hypercapnia were adopted as our practice. High frequency oscillatory ventilation (HFOV) and nitric oxide (NO) were applied, if necessary, since year 2000(period II). Sixty-seven cases of neonatal Bochdalek hernia from 1989 to 2005 were reviewed retrospectively. There were 33 and 34 cases in period I and II, respectively. The neonatal survival rates were 60.6 % and 73.5 %, respectively, but the difference was not significant. In period I, prematurity, low birth weight, prenatal diagnosis, inborn, and associated anomalies were considered as the significant poor prognostic factors, all of which were converted to nonsignificant in period II. In summary, improved survival was not observed in later period. The factors considered to be significant for poor prognosis were converted to be nonsignificant after change of the management principle. Therefore, we recommend delayed operation after sufficient period of stabilization and the avoidance of the routine insertion of chest tube. The validity of NO and HFOV needs further investigation.

• Neonatal Medicine
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• v.16 no.1
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• pp.64-70
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• 2009

Congenital diaphragmatic hernia (CDR) with severe pulmonary hypoplasia is associated with significant mortality. Recently, several new therapeutic methods have been suggested, such as high-frequency oscillatory ventilation and inhaled nitric oxide. For hypoxemic respiratory failure unresponsive to these advanced medical treatment options, extracorporeal membrane oxygenation (ECMO) serves as the last potentially effective treatment. An understanding of the pathophysiology of pulmonary hypertension associated with CDH led to a strategy involving preoperative stabilization and delayed surgical intervention with ECMO. We describe four cases of ECMO, including the first report of ECMO for neonatal CDH in Korea.

• Journal of Veterinary Clinics
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• v.21 no.1
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• pp.45-48
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• 2004

A five months old, female Himalayan cat was referred to the Veterinary Medical Teaching Hospital at Konkuk University, because of suspecting peritoneopericardial diaphragmatic hernia (PPDH). After consecutive examination, the patient was diagnosed as PPDH and hepatic dysfunction. In spite of medical therapy for a month, the serum chemistry profiles for liver enzymes (aspartate transferase: 469 U/L, alanine transferase: above analysis, gamma-glutamyl transferase: above analysis) did not decrease to the normal range. In operation, some of liver was necrotized and was adhesive to diaphragm, these were gently dissected from thoracic structures, and resected. After debriding, the edges of the defect of diaphragm were closed with a simple continuous suture pattern. One month after operation, the cat had normal condition, recovery was uncomplicated, and the serum chemistry profiles for liver enzymes decrease to the normal range.

• Journal of Trauma and Injury
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• v.32 no.4
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• pp.210-219
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• 2019

Purpose: Traumatic diaphragmatic injury (TDI) is no longer considered to be a rare condition in Korea. This study investigated differences in the prevalence of accompanying injuries and the prognosis in patients with traumatic diaphragmatic damage according to the mechanism of injury. Methods: We retrospectively reviewed the medical records of patients with TDI who were seen at a regional emergency medical center from January 2000 to December 2018. Among severe trauma patients with traumatic diaphragmatic damage, adults older than 18 years of age with a known mechanism of injury were included in this study. Surgery performed within 6 hours after the injury was sustained was defined as emergency surgery. We assessed the survival rate and likelihood of respiratory compromise according to the mechanism of injury. Results: In total, 103 patients were analyzed. The patients were categorized according to whether they had experienced a penetrating injury or a blunt injury. Thirty-five patients had sustained a penetrating injury, and traffic accidents were the most common cause of blunt injuries. The location of the injury did not show a statistically significant difference between these groups. Severity of TDI was more common in the blunt injury group than in the penetrating injury group, and was also more likely in patients with respiratory compromise. However, sex, the extent of damage, and the initial Glasgow coma scale score had no significant relationship with severity. Conclusions: Based on the findings of this study, TDI should be recognized and managed proactively in patients with blunt injury and/or respiratory compromise. Early recognition and implementation of an appropriate management strategy would improve patients' prognosis. Multi-center, prospective studies are needed in the future.

• Toxicological Research
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• v.2 no.1
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• pp.37-50
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• 1986

This paper describes the effects of nitrofen (Hi-TOK), a herbicide on the fetuses of rats. The results were observed as follows: The internal soft tissue anomalies were classified as diaphragmatic hernia, cardiac malformation (T.G.V., V.S.D., S.V.), dilatation of ventricle in brain, dilatation of renal pelvis, underdevelopment of fetal lung, shortening of cortex length and increasing of immatured glomeruli counts in the fetal kidney. The heart and diaphragm appear to be the target organs.