• Journal of Chest Surgery
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• 제20권4호
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• pp.839-846
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• 1987

The records of 10 patients with traumatic diaphragmatic hernia seen from November 1977 through July 1987 were reviewed. All the patients had a transdiaphragmatic evisceration of abdominal contents into the thorax. We treated 7 male and 3 female patients ranging in age from 3 to 62 years. In 8 patients, diaphragmatic hernia followed blunt trauma and in 2 patients, stab wounds to the chest. The herniation occurred on the right side in 3 patients and on the left side in 7. All the patients sustained additional injuries: rib fractures [7 patients], additional limb, pelvic and vertebral fractures [6], closed head injury [2], lung laceration [1], liver laceration [1], renal contusion [1], ureteral rupture [1], and splenic rupture [1]. Organs herniated through the diaphragmatic rent included the omentum [6 patients], stomach [4], liver [4], colon [3], small intestine [1], and spleen [1]. For right-sided injuries, the liver was herniated in all 3 patients and the colon, in 1. in the initial or latent phase, dyspnea, diminished breath sounds, bowel sounds in the chest were noted in 4 patients, and in the obstructive phase, nausea, vomiting, and abdominal pain were found in all 3 patients. Two patients had a diagnostic chest radiograph with findings of bowel gas patterns, and an additional 8 had abnormal but nondiagnostic studies. Hemothorax, pleural effusion or abnormal diaphragmatic contour were common abnormal findings. Three patients were operated on during the initial or acute phase [immediately after injury], 4 patients were operated on during the latent or intermediate phase [3 to 210 days], and 3 patients were operated on during the obstructive phase [10 to 290 days]. Six patients underwent thoracotomy, 2 required thoracoabdominal incision, and 2 had combined thoracotomy and laparotomy. Primary suture was used to repair the diaphragmatic hernia in 9 cases. One patient required plastic repair by a Teflon felt. Empyema was the main complication in 2 patients. In 1 patient, the empyema was treated by closed thoracostomy and in 1, by decortication and open drainage. There were no deaths.

• Advances in pediatric surgery
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• 제6권1호
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• pp.1-9
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• 2000

Despite of advances in perinatal management and treatment modalities congenital diaphragmatic hernia(CDH) remains a frustrating problem. Although the sheep has proven to be a reliable experimental model for the production of intrauterine CDH, the rabbit may have some advantages. These include lower cost, smaller body size, year-round availability, high number of fetuses per pregnancy, and short gestational period. To evaluate the feasibility of the rabbit model of CDH, twenty-seven pregnant New Zealand rabbits were utilized. Hysterotomy and an operative procedure for creating a diaphragmatic defect on gestational day 24 or 25, in two fetuses of each pregnant rabbit were performed. In one fetus of one cornu of the uterus, the left fetal diaphragm was excised through an open thoracotomy(DH group). In another fetus in the other cornu, CDH was created and the trachea clipped(Surgiclip, USSC, Norwalk, Conn., USA) (TL group). Delivery was by Cesarean section on 30 days of gestation. Among twenty- seven pregnant rabbits, 12 in the DH group and eight in the TL group were born alive. The most common herniated organ was the left lobe of the liver. In thee DH group, the lungs were hypoplastic with decreased lung weight/body weight ratio, reduced numbers of alveoli, thicker media of the pulmonary arteries, and immature alveoli. In TL group, the alveoli were more mature and did not differ from the control animals. In conclusion, (1) pulmonary hypoplasia develops in the fetal rabbit diaphragmatic hernia model and (2) simultaneous tracheal ligation prevents pulmonary hypoplasia.

• Toxicological Research
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• 제2권1호
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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.

• 한국임상수의학회지
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• 제33권4호
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• pp.237-242
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• 2016

A 1.86 kg, 3-year-old, female, Maltese was presented to the Veterinary Medical Teaching Hospital of Seoul National University after being hit by a car. The patient was diagnosed with urinary bladder rupture, diaphragmatic hernia and fracture of ilium, tibia and fibula. Repair surgery was performed after stabilizing treatment. During the surgery, hypoxia was identified and it worsened after positive pressure ventilation (partial pressure of oxygen in arterial blood ($PaO_2$): 52 mmHg, pulse oximetry ($SpO_2$): 87%, arterial hemoglobin oxygen saturation ($SpO_2$): 85.8%). In addition to hypoxia, blood pressure decreased to 30 mmHg. Positive pressure ventilation was discontinued because hypoxia and hypotension were aggravated. After suturing the diaphragm, air was withdrawn to form negative pressure within the thorax. However, negative pressure was not attained despite continuous withdrawal of air. A thoracostomy tube was placed because tension pneumothorax was strongly suspected. The patient recovered through close monitoring with the tube for 3 days. Due to limitation of evaluation of the lung, predicting occurrence of tension pneumothorax is difficult in patient of diaphragmatic hernia. Therefore, it is recommended that indicators of tension pneumothorax should be closely monitored during diagnosis and repair procedures of diaphragmatic hernia.

• Advances in pediatric surgery
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• 제17권2호
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• pp.179-187
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• 2011

Experimental tracheal ligation (TL) has been shown to reverse the pulmonary hypoplasia associated with congenital diaphragmatic hernia (CDH) and to normalize gas exchange. The purpose of this study was to determine whether the TL would correct the surfactant deficiency present in the fetal rabbit model of CDH by using lamellar body count. Lamellar bodies are synthesized and secreted by the type II pneumocytes of fetal lung. The phospholipids present in these bodies constitute the major component of pulmonary surfactant. Twenty-one pregnant New Zealand rabbits underwent hysterotomy and fetal surgery on gestational day 24. Two fetuses of each pregnant rabbit were operated. In the fetus of one end of bicornuate uterus, left DH was created by excision of fetal diaphragm through open thoracotomy (DH Group). In the fetus of the other end of bicornuate uterus, left DH and TL were created (TL Group). The fetuses were delivered by Cesarean section on gestational day 31. Fourteen in control group, 12 in the DH group and 13 in TL group were born alive. En bloc excision of lungs, bronchi and trachea was done in all newborn rabbits. A five Fr catheter was inserted through trachea and repeated irrigations with 10 cc normal saline were done. The irrigated fluid was centrifuged at $280{\times}g$ for 5 minutes and the lamellar bodies were counted with the upper level fluid in platelet channel of electronic cell counter. The average lamellar body counts were $37.1{\pm}14.2{\times}10^3/{\mu}L$ in control group, $11.5{\pm}4.4 {\times}10^3/{\mu}L$ in DH group, and $6.5{\pm}0.9{\times}10^3/{\mu}L$ in TL group. Lamellar body count in DH group was lower than in control group and did not increase after TL. This study shows TL has no therapeutic effect on decreased surfactant level of CDH and the pregnant rabbit is appropriate for the animal model of CDH.

• Neonatal Medicine
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• 제25권3호
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• pp.102-108
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• 2018

Purpose: Congenital diaphragmatic hernia (CDH) is rare but potentially fatal. The overall outcome is highly variable. This study aimed to identify a simple and dynamic parameter that helps predict the mortality of CDH patients in real time, without invasive tests. Methods: We conducted a retrospective chart review of 59 CDH cases. Maternal and fetal information included the gestational age at diagnosis, site of defect, presence of liver herniation, and lung-to-head ratio (LHR) at 20 to 29 weeks of gestational age. Information regarding postnatal treatment, including the number of days until surgery, the need for inhaled nitric oxide (iNO), the need for extracorporeal membrane oxygenation (ECMO), and survival, was collected. The highest respiratory severity score (RSS) within 24 hours after birth was also calculated. Results: Statistical analysis showed that a younger gestational age at the initial diagnosis (P<0.001), a lower LHR (P=0.001), and the presence of liver herniation (P=0.003) were prenatal risk factors for CDH mortality. The RSS and use of iNO and ECMO were significant factors affecting survival. In the multivariate analysis, the only remaining significant risk factor was the highest preoperative RSS within 24 hours after birth (P=0.002). The area under the receiver operating characteristic curve was 0.9375, with a sensitivity of 91.67% and specificity of 83.87% at the RSS cut-off value of 5.2. The positive and negative predictive values were 82.14% and 92.86%, respectively. Conclusion: Using the RSS as a prognostic predictor with simple calculations will help clinicians plan CDH management.

• Journal of Chest Surgery
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• 제42권1호
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• pp.115-118
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• 2009

중부 식도암에서 개흉적 식도절제술을 시행 받은 65세 남자가 식도열공 직상부의 좌측 종격 흉막이 찢어진 곳을 통해 횡행결장의 흉강내 탈장이 발생하였다. 단순흉부촬영상 좌측 하폐야에 공기음영의 누적이 발견되었고 이는 점차 진행하여 좌측 폐를 완전히 허탈시키고 혈역학적 불안정을 야기하였다. 식도절제술 후 생명을 위협하는 흉강내로의 탈장은 응급 개복술을 통하여 교정되었다. 식도절제술 후 식도열공을 통한 흉강내 탈장은 장의 폐색이나 꼬임의 위험 때문에 생명을 위협할 가능성이 있어 증상이 있는 환자에서 응급으로 복부절개를 통한 탈장의 수술적 복원을 시행하여야 한다. 하지만 식도절제술시 이러한 합병증의 예방을 위한 신중이 최우선일 것이다.

• 대한두경부종양학회지
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• 제27권1호
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• pp.77-79
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• 2011

Tracheal diverticulum is very rare, that is usually an incidental finding at routine chest computed tomography scan. Differential diagnosis of tracheal diverticulum includes pharyngocele, laryngocele, Zenker diverticulum, apical lung hernia, blebs and bulla, and pneumomediastinum. Treatment options can be devided into medical and surgical. The majority of patients is asymptomatic and requires no specific intervention. We experienced one case of tracheal diverticulum in patient with tongue cancer and report it with reviews of literature.

• Journal of Chest Surgery
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• 제40권11호
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• pp.802-804
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• 2007

선천성 횡격막 탈장이 동반된 흉강내 이소성 간은 드물지 않게 보고되고 있으나 횡격막 탈장이 동반되지 않은 흉강내 이소성 간은 매우 희귀한 선천성 질환이다. 횡격막 탈장이 동반되지 않은 흉강내 이소성 간을 체험하였기에 증례를 보고한다. 환자는 37세 여자로, 우연히 발견된 폐종양의 치료를 위해 내원하였다. 흉부 컴퓨터단층촬영 스캔상 우측 폐하엽에 횡격막에 인접해 있는 폐종양이 확인되었으며, 기관지 유암종을 의심하고 수술을 시행하였다. 수술 소견상, 우측 횡격막 중심부에 지름 3.5cm와 2.0 cm정도의 2개의 둥근 종양이 위치하고 있었으며, 종양의 절제를 시행하였다. 병리학적으로 흉강내 이소성 간으로 확진되었고, 환자는 수술 후 특별한 문제없이 퇴원하였다.

• Advances in pediatric surgery
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• 제20권1호
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• pp.1-6
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• 2014

Minimal invasive surgery (MIS) has rapidly gained acceptance for the management of a wide variety of pediatric diseases. A questionnaire was sent to all members of the Korean Association of Pediatric Surgeons. Thirty one members (25.4%) took part in the survey that included data for the year 2012: demographic details, opinion regarding minimal invasive surgery and robotic surgery, spectrum of minimally invasive operations, and quantity of procedures. 48.4% of the respondents had more than 10 years experience, 35.5% less than 10 years experience, and 16.1 % had no experience. The respondents of the recommend MIS and perform MIS for surgical procedures are as follow; inguinal hernia (61.3%), simple appendicitis (87.1%), complicated appendicitis (80.6%), reduction of intussusceptions (83.9%), pyloromyotomy (90.3%), fundoplication (96.8%), biopsy and corrective surgery of Hirschsprung's disease (93.5%/90.3%), imperforate anus (77.4%), congenital diaphragmatic hernia (80.6%), and esophageal atresia (74.2%). The MIS procedures with more than 70% were lung resection (100%), cholecystectomy (100%), appendectomy (96.2%), ovarian torsion (86.7%), fundoplication (86.8%), hiatal hernia repair (82.6%), and splenectomy (71.4%). The MIS procedures with less than 30% were congenial diaphragmatic hernia reapir (29.6%), esophageal atresia (26.2%), correction of malroatation (24.4%), inguinal hernia repair (11.4%), anorectal malformation (6.8%), Kasai operation (3.6%).