• Korean Journal of Veterinary Research
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• v.48 no.2
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• pp.209-213
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• 2008

A four-month-old intact femlae Abyssinian cat was present for routine health evaluation, because her littermate was recently died of ventricular septal defect. Diagnostic imaging studies showed a large caudal paracardiac mass in thoracic radiography and homogenous mass adjacent to heart in the echocardiography. Further echographic study revealed that the mass was liver and the diaphragmatic line was intact. The positive contrast celiogram revealed that no extravasation of the contrast media across the diaphragm and the prolapse of diaphragm into the pleural cavity. Based on our diagnostic imaging studies, the case was diagnosed as diaphragmatic deformity in a cat mimicking a cardiac mass.

• Advances in pediatric surgery
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• v.16 no.2
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• pp.143-153
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• 2010

Congenital diaphragmatic disease is one of the common major congenital anomalies, and its mortality remained still high despite recent medical advances. The aim of this study is to examine the clinical characteristics of congenital diaphragmatic diseases. A total of 39 patients with congenital diaphragmatic disease that underwent surgery from January, 1997 to December, 2009 at Pusan National University Hospital were included in this study. Medical records were retrospectively reviewed. The male to female ratio was 30:9. Six out of 39 cases died (NS) before surgery, 17 patients had Bochdalek's hernia (BH), 11 patients hiatus hernia (HH), 4 diaphragmatic eventration (DE), and 1 Morgagni hernia (MH). There were no differences in mean birth weight and mean gestational age. NS (83.3 %). BH (35.3 %) was diagnosed more frequently than other diseases in the prenatal period. Three patients (17.6 %) of BH expired due to pulmonary hypoplasia and 1 patient had co-existing congenital heart disease. BH was diagnosed more frequently in the prenatal stage and had a higher motality rate than other conditions. Therefore, BH needs to be concentrated more than other anomalies.

• Journal of Chest Surgery
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• v.6 no.2
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• pp.243-248
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• 1973

Eventration of the diaphragm is, by definition, abnormally high or elevated position of diaphragm as a result of paralysis, aplasia or atrophy of varing degrees of muscle fibers, and the cause of which may be congenital or acquired. The unbroken continuity of the diaphragm differentiates it from diaphragmatic hernia. The clinical manifestations of the condition, if present, are usually due to the interference of the ventilatory function of the lung and digesive dysfunction due to gastrointestinal distorsion. Treatment consists of surgical repair of the relaxed diaphragm to it`s normal position. A ease of left sided eventuration of the diaphragm, 31 year old officer, was found by chance after traffic accident with chief complaints of hemoptysis and multiple superficial contusions. Routine chest roentgenogram and barium study of the colon revealed moderately elevated left hemidiaphragm with displacement of the splenic flexure of the colon into the left chest. Past history revealed frequent attack of upper respiratory infection and some abnormal condition on his left chest announced by screen cheek of chest X-ray at the time of entrance for his army service 3 years before. Plication of the relaxed diaphragm through left thoracotomy was done and result was excellent as seen on Fig. 5. Cause of eventration of the left hemidiaphragm was due to paralysis of the left phrenic nerve which was tested during thoracotomy.

• Journal of Chest Surgery
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• v.49 no.6
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• pp.456-460
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• 2016

Background: Surgical correction needs to be considered when diaphragm eventration leads to impaired ventilation and respiratory muscle fatigue. Plication to sufficiently tense the diaphragm by VATS is not as easy to achieve as plication by open surgery. We used pneumatic compression with carbon dioxide ($CO_2$) gas in thoracoscopic diaphragmatic plication and evaluated feasibility and efficacy. Methods: Eleven patients underwent thoracoscopic diaphragmatic plication between January 2008 and December 2013 in Pusan National University Hospital. Medical records were retrospectively reviewed, and compared between the group using $CO_2$ gas and group without using $CO_2$ gas, for operative time, plication technique, duration of hospital stay, postoperative chest tube drainage, pulmonary spirometry, dyspnea score pre- and postoperation, and postoperative recurrence. Results: The improvement of forced expiratory volume at 1 second in the group using $CO_2$ gas and the group not using $CO_2$ gas was $22.46{\pm}11.27$ and $21.08{\pm}5.39$ (p=0.84). The improvement of forced vital capacity 3 months after surgery was $16.74{\pm}10.18$ (with $CO_2$) and $15.6{\pm}0.89$ (without $CO_2$) (p=0.03). During follow-up ($17{\pm}17$ months), there was no dehiscence in plication site and relapse. No complications or hospital mortalities occurred. Conclusion: Thoracoscopic plication under single lung ventilation using $CO_2$ insufflation could be an effective, safe option to flatten the diaphragm.

• Journal of Chest Surgery
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• v.35 no.10
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• pp.730-735
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• 2002

Diaphragm is innervated by phrenic nerve and lower intercostal nerves. For patients with avulsion injury of brachial plexus, an in situ graft of phrenic nerve is frequently used to neurotize a branch of the brachial plexus. We studied short-term and mid-term changes of diaphragmatic level and movement in patients with dissection of phrenic nerve for neurotization. Material and Method : Thirteen patients with division of either-side phrenic nerve for neurotization of musculocutaneous nerve were included in this study. With endoscopic surgical procedure, the intrathoracic phrenic nerve was entirely dissected and divided just above the diaphragm. The dissected phrenic nerve was taken out through thoracic inlet and neck wound and then anastomosed to the musculocutaneous nerve through a subcutaneous tunnel. With chest films and fluoroscopy, levels and movements of diaphragm were measured before and after operation. Result : There was no specific technical difficulty or even minor postoperative complications following endoscopic division of phrenic nerve. After division of phrenic nerve, diaphragm was soon elevated about 1.7 intercostal spaces compared with the preoperative level, but it did not show paradoxical motion in fluoroscopy. More than 1.5 months later, diaphragm returned downward close to the preoperative level (average level difference was 0.9 intercostal spaces; p＝NS). Movement of diaphragm was not significantly decreased compared with the preoperative one. Conclusion : After division of phrenic nerve, the affected diaphragm did not show a significant decrease in movement, and the elevated diaphragm returned downward with time. However, the decreased lung volumes in the last spirometry suggest the decreased inspiratory force following partial paralysis of diaphragm.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.22 no.6
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• pp.608-612
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• 2019

Gastric volvulus (GV) is an uncommon pathology, with 10-20% of cases occurring in children, typically before one year of age. It often occurs in people with congenital diaphragmatic hernias, intestinal malrotation, eventration of the diaphragm, paraesophageal hernias, wandering spleens, asplenism, or intra-abdominal adhesions. We report a rare case of chronic GV after left hemihepatectomy for hepatoblastoma in a child. The patient was a 9-year-old boy who complained of upper abdominal pain and postprandial upper abdominal distension for one year. At the age of 4 months, he was diagnosed with hepatoblastoma and had undergone left hemihepatectomy. The upper gastrointestinal contrast study revealed chronic organoaxial gastric volvulus. After a surgical procedure involving adhesiolysis and an anterior wall gastropexy, the patient improved and the symptoms resolved. Although GV is a rare disease, it should be suspected in a patient with a previous abdominal surgical history who is complaining of abdominal distension and pain.

• Journal of Chest Surgery
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• v.43 no.5
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• pp.513-517
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• 2010

Background: Diaphragmatic plication through a thoracoscopic approach has been an effective modality to treat diaphragmatic enventration. However, the conventional technique for thoracoscopic plication has some disadvantages. We have developed an improved and simplified technique with utilizing the head up position, $CO_2$ insufflation and figure-of-eight sutures. Material and Method: Between October 2005 and September 2009, 9 patients with diaphragmatic paralysis underwent repair using our modified technique. The mean patient age was $38.5{\pm}53.0$ years (range: 2~76 years). Result: The mean operation time was $46.7{\pm}15.9$ min (range: 30~85 min). None of the patients died due to this procedure, but there was one case of prolonged air leakage, and a case of re-expansion pulmonary edema, which required 3 days of ventilator support after the procedure. The mean hospital stay was $6.22{\pm}2.04$ days (range: 4~11 days). The mean follow-up duration was $27.2{\pm}11.6$ months (range: 2~43 months). All the patients had their symptoms relieved and there was no recurrence of eventration except for one patient who developed more than 2 cm elevation of the diaphragm compared to the immediate post-operation status. Conclusion: With our technique, thoracoscopic diaphragmatic plication was feasible via using only three 5 mm ports and without a working window and the midterm results were favorable. Therefore, we advocate thoracoscopic diaphragmatic plication as a preferred technique to the conventional open plication technique.