• Journal of Chest Surgery
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• v.31 no.2
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• pp.162-167
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• 1998

Between January 1976 and March 1997, six patients with delayed presentation of traumatic diaphragmatic hernia occured among the 52 patients of traumatic diaphragm rupture, of whom four males and two females, five by blunt trauma and one by stab wound, one was right side and the rest were left side. In all patients, reduction of herniated organs was accomplished by thoracotomy or thoracotomy with extension to abdomen. Suspicion of the diaphragmatic ruture from the acute traumatic chest injured patient is important and we can use the videothoracoscopy for evaluation and treatment of the traumatic diaphragm rupture

• Journal of Korean Academy of Nursing
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• v.29 no.6
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• pp.1304-1313
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• 1999

Breathing is essential for life and at the same time takes a role as a antidote for stress. In the Orient, it was recognized early that respiration, mind, and body have a relation that is inseparable and therefore proper breathing is so important. However, since the mechanism of therapeutic effect by breathing have not been verified, the treatment has been continued till recent years. From that which originated in the Orient, several techniques in the west have been developed to regulate breathing, and have been applying to the clinical situation and to studies, however scientific studies are still lacking. Recently, relaxed breathing has been used as an efficient strategy for breathing therapy as it has an effect on reducing physiological tension and arousal, and, therefore can be used as a basic technique to control or manage stress. In this study, in order to provide basic information and guidelines for clinical application, which will aid in the application of the theoretical basics of breathing therapy and its technique, a review of the literative was conducted. The findings are as follows: 1. Since proper breathing not only has, physically, the important function in supplying oxygen to the body but also gives a good emotional, or pleasant state of mind, it is the first step in controlling physical and mental health. 2. The basic types of breathing can be classified into two types; ‘diaphragmatic breathing(relaxed breathing)’ and ‘chest breathing(stress breathing)’. In yoga type breathing, there are four kinds of breathing, ‘upper breathing’, ‘mid breathing’, ‘down breathing’, and ‘complete breathing’. 3. The theoretical explanation of the positive thera peutic effect of breathing therapy techniques exemplifies good brain function, sufficient air flow through the nasal passages, diaphragmatic movement, light vagal stimulation, CO2 changes and cognitive diversion but in most studies, the hypothesis of CO2 is supported. 4. The technique of breathing is designated with many names according to the muscles and techniques used for breathing, and for control of stress, diaphragmatic breathing(relaxed breathing) is explained as a basic technique best used to manage of stress. 5. The relaxed-breathing includes slow diaphragmatic breathing, breath meditation, nasal breathing, yogic abdominal breathing, Benson's relaxed response, and quiet response.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.12 no.2
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• pp.246-250
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• 2009

Congenital diaphragmatic hernias (CDH) usually cause respiratory distress soon after birth and are associated with a high mortality rate in the early postnatal period. However, there is a milder form of CDH that does not manifest during the neonatal period. The late presenting CDH is characterized by a variable clinical picture. We present the case of an otherwise healthy 5-month-old girl, who was referred for evaluation of an 1-day history of vomiting and irritability. Chest simple X-ray and CT showed bowel loops in the left thoracic cavity, which was consistent with diaphragmatic hernia. At operation, she was found to have a small left posterolateral diaphagmatic defect with viable small bowel loops in the left thoracic cavity. After surgical reposition of the hernia, the symptoms such as vomiting and irritability subsided. The lack of typical manifestation of CDH such as respiratory distress may lead to delayed diagnosis. The possibility of late presenting CDH should not be overlooked even after the neonatal period.

• Tuberculosis and Respiratory Diseases
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• v.45 no.4
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• pp.736-745
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• 1998

Background: Respiratory muscle interaction is further profoundly affected by a number of pathologic conditions. Hyperinflation may be particularly severe in chronic obstructive pulmonary disease(COPD) patients, in whom the functional residual capacity(FRC) often exceeds predicted total lung capacity(TLC). Hyperinflation reduces the diaphragmatic effectiveness as a pressure generator and reduces diaphragmatic contribution to chest wall motion. Ultrasonography has recently been shown to be a sensitive and reproducible method of assessing diaphragmatic excursion. This study was performed to evaluate how differences of diaphragmatic excursion measured by ultrasonography associate with normal subjects and COPD patients. Methods: We measured diaphragmatic excursions with ultrasonography on 28 healthy subjects(l6 medical students, 12 age-matched control) and 17 COPD patients. Ultrasonographic measurements were performed during tidal breathing and maximal respiratory efforts approximating vital capacity breathing using Aloka KEC-620 with 3.5 MHz transducer. Measurements were taken in the supine posture. The ultrasonographic probe was positioned transversely in the midclavicular line below the right subcostal margin. After detecting the right hemidiaphragm in the B-mode the ultrasound beam was then positioned so that it was approximately parallel to the movement of middle or posterior third of right diaphragm. Recordings in the M-mode at this position were made throughout the test. Measurements of diaphragmatic excursion on M-mode tracing were calculated by the average gap in 3 times-respiration cycle. Pulmonary function test(SensorMedics 2800), maximal inspiratory(PImax) and expiratory mouth pressure(PEmax, Vitalopower KH-101, Chest) were measured in the seated posture. Results: During the tidal breathing, diaphragmatic excursions were recorded $1.5{\pm}0.5cm$, $1.7{\pm}0.5cm$ and $1.5{\pm}0.6cm$ in medical students, age-matched control group and COPD patients, respectively. Diaphragm excursions during maximal respiratory efforts were significantly decreased in COPD patients ($3.7{\pm}1.3cm$) when compared with medical students, age-matched control group($6.7{\pm}1.3cm$, $5.8{\pm}1.2cm$, p< 0.05}. During maximal respiratory efforts in control subjects, diaphragm excursions were correlated with $FEV_1$, FEVl/FVC, PEF, PIF, and height. In COPD patients, diaphragm excursions during maximal respiratory efforts were correlated with PEmax(maximal expiratory pressure), age, and %FVC. In multiple regression analysis, the combination of PEmax and age was an independent marker of diaphragm excursions during maximal respiratory efforts with COPD patients. Conclusion: COPD subjects had smaller diaphragmatic excursions during maximal respiratory efforts than control subjects. During maximal respiratory efforts in COPD patients, diaphragm excursions were well correlated with PEmax. These results suggest that diaphragm excursions during maximal respiratory efforts with COPD patients may be valuable at predicting the pulmonary function.

• Journal of Chest Surgery
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• v.17 no.4
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• pp.729-734
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• 1984

Bochdalek hernia is a type of congenital diaphragmatic defect in the posterolateral portion of the diaphragm. The defect is usually Lt. sided due to protective effect of liver on right. Sex distribution is male preponderance [2:1] and it is diagnosed during neonate, mostly first 24 hours, due to severe respiratory distress. We experienced a rare case of old aged female patient with congenital Bochdalek hernia on Rt. side which was found incidentally during treatment of spontaneous pneumothorax of Rt. side. 17 year old female patient was admitted to CS department for chest discomfort on right and mild dyspnea with duration of 20 days. Under the diagnosis of spontaneous pneumothorax, Rt. closed thoracostomy and underwater sealed drainage with continuous suction was applied. On follow-up chest x-ray, poorly defined hazy increased density with multiple air-fluid levels in Rt. lower lung field and Lt. subphrenic free air were noted. So, Barium enema was done under the impression of Rt. diaphragmatic hernia, and nearly entire colon proximal to sigmoid was demonstrated in the Rt. hemithorax. Operation was done-for surgical repair of defected diaphragm through Rt. posterolateral thoracotomy. Operative findings were as follows; 1.Hypoplastic Rt. lung, esp. RML & RLL. 2.Nearly entirely intestines were herniated. 3.Diaphragmatic defect was located on posterolateral portion of the diaphragm, about 10x3cm in size with blunt smooth margin. 4.A large bleb on apex of RUL of lung. Herniated intestines were repaired into abdominal cavity manually and defect of diaphragm was repaired with No. I black silk interrupted sutures directly, and bleb was resected. Postoperative courses were uneventful and the patient was discharged with good condition on POD 14th.

• Journal of Chest Surgery
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• v.48 no.5
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• pp.307-310
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• 2015

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 $6.3{\pm}2.5days$. The mean follow-up period was $24.3{\pm}14.5months$. 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.

• Journal of Trauma and Injury
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• v.23 no.1
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• pp.49-52
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• 2010

A hemothorax usually occur, due to injuries to the intercostal and great vessels, pulmonary damage, and sometimes fractured ribs. We report a case in which the hemothorax that occurred, neither intrathoracic injury nor injury to internal thoracic vessels and organs, via lacerated diaphragmatic and liver laceration due to a right upper part of anterior chest stab injury caused by a sharp object. The patient's general conditions gradually worsened, so chest and abdominal computed tomogram were taken. The abdominal computed tomogram revealed diaphragmatic injuries and bleeding from the lacerated liver. We performed an exploratory laparotomy to control the bleeding from the lacerated liver with simple primary sutures. In addition exploration was performed in the right pleural space through the lacerated diaphragm with a thoracoscopic instrument. There were no bleeding foci in the right pleural space, the vessels, or the lung on the thoracoscopic video. Closure of the lacerated diaphragm was achieved with simple, primary sutures. The postoperative course of the patient was uneventful, and the patient was discharged.

• Journal of Gastric Cancer
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• v.12 no.1
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• pp.49-52
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• 2012

Through the advent of surgical techniques and the improvement of laparoscopic tools including the ultrasonic activated scissor, laparoscopic gastrectomy has been increasingly used in far more cases of benign or malignant gastric lesions for the benefit of patients without compromising therapeutic outcomes. Even though possible complications provoked by the ultrasonic activated scissor can be prevented during the procedure with increasing advanced laparoscopic experience and supervision, unexpected late complications after the operations rarely occur. An extremely rare case of left incarcerated diaphragmatic hernia of the transverse colon developed in an 81-year-old female patient as a late complication, 8 months after laparoscopy-assisted total gastrectomy for gastric cancer, with laparoscopy successfully resumed and without the need to sacrifice any portion of the bowel.

• Journal of Chest Surgery
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• v.25 no.12
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• pp.1542-1549
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• 1992

From March 1986 to August 1992, 18 patients underwent diaphragmatic plication for the diaphragmatic paralyses complicating various pediatric cardiac procedures. Age at operation ranged from 16 day to 84 months with mean age of 11.8 months. In order of decreasing incidence, the primary cardiac procedures included modified Blalock-Taussig shunt [ 5 ], Arterial switch operation [ 4 ], modified Fontan operation [ 2 ], and others [ 7 ]. The suspicious causes of phrenic nerve injury included overzealous pericardial resection [ 7 ], direct trauma during the procedure [ 6 ], dissection of fibrous adhesion around the phrenic nerve [ 3 ] and unknown etiology [ 2 ]. The involved sides of diaphragm were right in 10, left in 7 and bilateral in one. The diagnosis was suspected by the elevation of hem-idiaphragm on chest x-ray and confirmed by fluoroscopy. The interval between primary operation and plication ranged from the day of operation to 38 postoperative days [mean : 14 days]. The method of plication were "Central pleating technique" described by Schwartz in 16 and other techniques in 2. Five patients expired after plication and the cause of death were not thought to be correlated directly with the plication itself. In the remaining 13 survivors, extubation or cessation of positive ventilation could be done between the periods of the day of plication and 14th postoperative days [mean; 3.8day]. We have made the following conclusions : 1] Phrenic nerve paralyses are relatively common complication after pediatric cardiac procedures and the causes of phrenic nerve injury are mostly preventable; 2] Phrenic nerve palsy is associated with corisiderable morbidity; 3] diaphragmatic plication is safe, reliable and can be applicable in patients who are younger age and require prolonged positive pressure ventilation.ntilation.

• Korean Journal of Applied Biomechanics
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• v.23 no.3
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• pp.279-284
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• 2013

The purpose of this study was to determine the effect of head posture and respiratory pattern on muscle activities of sternocleidomastoid (SCM) and scalene during maximal respiration. The seventeen subjects with upper-costal breathing pattern were participated in this study. Surface electromyography was used to measure the muscles activities of SCM and scalene. The volume and velocity of inspiration were monitored by using the spirometer in each subject. Each subject was performed the 3-cycle of respiration in each condition. The mean values of three peak muscle activity in each muscle were used in the data analysis. A2 (head posture: forward head posture: FHP vs. neutral posture) X 2 (breathing pattern: costal vs. diaphragmatic) repeated-measures analysis of variance (ANOVA) was used to compare the normalized muscle activities of the SCM and scalene. The results showed that the muscle activities of SCM and scalene in diaphragmatic breathing were significantly lower than those in costal breathing for each head posture (p<.0125). The muscle activities of SCM in neutral position were lower than those in forward head position during costal breathing (p<.0125). The diaphragmatic breathing in neutral position of head is recommended to decrease the tension of the accessory inspiratory muscles during respiration in neck-pain patients with FHP.