389 results on '"abdominal wall defects"'
Search Results
102. "Is anemia frequently recognized in gastroschisis compared to omphalocele? A multicenter retrospective study in southern Japan" by Sugita, K et al.
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Govani, Devkumar Jitendra, Trambadia, Rajvi Anilkumar, Chhaniara, Rohan Ashit, Mirani, Zankhan Ramkishan, Midha, Partap Kumar, Correia, Rafael Cavalcante, and Patel, Ramnik V
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- 2022
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103. Morbimortality of newborns with omphalocele in a Level III Neonatal Intensive Care Unit
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Sofia Vasconcelos, Susana Pissarra, Filipa Flor de Lima, and Hercília Guimarães
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omphalocele ,congenital abnormalities ,abdominal wall defects ,prenatal diagnosis ,outcome ,newborn ,Medicine ,Pediatrics ,RJ1-570 - Abstract
Background: Omphalocele is a midline abdominal hernia that conditions important rates of mortality and morbidity. Infants born with omphalocele present an increased risk of having structural and chromosomal anomalies or syndromes. It is a defect that requires surgical treatment with multiple postoperative comorbidities. Purpose: To identify and characterize the cases of omphalocele of a Level III Neonatal Intensive Care Unit and analyse the impact of clinical and demographic characteristics of both infant and mother in patients’ outcome. Methods: This is a retrospective study based on the record analysis of infants that have been hospitalized in the Neonatal Intensive Care Unit of “Centro Hospitalar de São João” with the diagnosis of omphalocele between 2003 and 2012. Sixteen patients fulfilled these criteria. For each one, data about pregnancy, maternal history, prenatal diagnosis, delivery, newborn, treatment and follow-up was collected and analysed. Results: The mean birth weight was 2,761 grams and the mean gestational age was 37 weeks. Prenatal diagnosis was performed in 12 (75%) of the cases; mean gestational week of diagnosis was lower in patients that died. Overall, 50% (80% of deceased patients) had large defects. Major malformations were seen in 25% of cases most often in deceased infants. Low 1st minute Apgar score, need of inotropic support, more days of parenteral nutrition and lower birth weight had statistically significant impact on mortality. After surgical correction 31.3% died, 18.8% had a residual hernia and 12.5% a gastroesophageal reflux, respectively. Conclusion: The mortality rates of patients with the diagnosis of omphalocele are not negligible because of associated anomalies or postoperative complications. We have been able to correlate some clinical features with mortality and found out that patients who survive can have other comorbidities mainly in the first years of life. However the majority of infants are expected to have a good long-term development and quality of life.
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- 2014
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104. Post-Oncologic Abdominal Wall Reconstruction: Mesh Versus Autologous Tissue
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Karami, Reem, Ghieh, Fadi, and Ibrahim, Amir
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- 2020
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105. Outcomes in infants with prenatally diagnosed gastroschisis and planned preterm delivery.
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Mesas Burgos, Carmen, Svenningsson, Anna, Vejde, Jenny, Granholm, Tina, Conner, Peter, and Vejde, Jenny Hammarqvist
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GASTROSCHISIS , *PREMATURE labor , *PRENATAL care , *CESAREAN section , *ARTIFICIAL respiration , *DIAGNOSIS , *DELIVERY (Obstetrics) , *LENGTH of stay in hospitals , *PREMATURE infants , *LONGITUDINAL method , *PRENATAL diagnosis , *RETROSPECTIVE studies , *SURGICAL complications - Abstract
Background: The timing and mode of delivery of pregnancies with prenatally diagnosed gastroschisis remains controversial.Aim: To evaluate the outcome of patients with gastroschisis managed during two time periods: 2006-2009 and 2010-2014, with planned elective cesarean delivery at 37 versus 35 gestational weeks (gw). A secondary aim was to analyze the outcome in relation to the gestational age at birth.Material and Methods: Retrospective review of all cases with gastroschisis managed at our institution between 2006 and 2014.Results: Fifty-two patients were identified, 24 during the initial period, and 28 during the second. There were a significantly higher number of emergency cesarean deliveries in the first period. There were no differences between groups with regard to the use of preformed silo, need of parenteral nutrition or length of hospital stay. When analyzing the outcome in relation to the gw the patients actually were born, we observed that patients delivered between 35 and 36.9 gw were primary closed in 88.5% of cases, with shorter time on mechanical ventilation, parenteral nutrition and hospital stay.Conclusion: Planned caesarian section at 35 completed gestational weeks for fetuses with prenatally diagnosed gastroschisis is safe. We observe the best outcome for patients born between 35 and 36.9 gw. [ABSTRACT FROM AUTHOR]- Published
- 2015
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106. Registry analysis supports different mechanisms for gastroschisis and omphalocele within shared developmental fields.
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Benjamin, Bonna and Wilson, Golder N.
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Nine thousand two hundred eighty abnormalities associated with 2,943 abdominal wall defects (AWD) encoded from 1999 to 2008 by the Texas Birth Defects Registry (TBDR) were classified and analyzed for mechanism, beginning with 1,831 gastroschisis cases, 774 (41%) with 2,368 associated anomalies (AA) and 814 of omphalocele, 727 (89%) with 4,092 AA. Typical AA profiles for Trisomy 18 (23% of omphalocele cases) and Beckwith-Wiedemann syndrome (15%) validated registry AA descriptors, chromosome disorders surprisingly accounting for 24% of known conditions with gastroschisis followed by expected amniotic band (ADAM) complex (23%) and amyoplasia/arthrogryposis (16%). Separation of known diagnoses, fetal-stillbirth cases, and transitional or secondary AA left 330 cases of gastroschisis with 594 AA (452 major, 142 minor) and 295 cases of omphalocele with 956 AA (683 major, 273 minor). Anomalies suggestive of vascular origin (intestinal atresias, amyoplasia, bands) were more frequent with gastroschisis and those of defective lateral folding (exstrophies, limb-body wall defects) with omphalocele. Most AA favoring omphalocele had parallel frequencies with gastroschisis, whether by system/region-for example, cardiac AA (10% of cases), contractures (4.7%), limb (3.7%), CNS (3.2%) for gastroschisis versus cardiac (35%), contractures (14%), digestive-excretory-trunk-axial (all ∼11%), CNS (9.9%) for omphalocele-or for particular minor/major AA-for example, micrognathia (0.72% versus 3.3%), spina bifida (0.59% versus 3.9%), anal atresia (0.73% versus 6.4%), two-vessel cord (0.22% versus 5.6%). Similar frequencies of many AA reflective of early patterning support common AWD origin within early developmental fields and reinforce the use of large birth defect numbers from suitably qualified registries to define anomaly mechanism as well as prevalence. © 2015 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]
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- 2015
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107. Prenatal diagnosis of fetal gastroschisis - The experience of Maternal-Fetal Medicine Centre in Olsztyn.
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Samusionek, Karolina Loewenau, Szmyt, Małgorzata, Hoppe, Tomasz, and Warowicka, Ewa Szwałkiewicz
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PRENATAL diagnosis , *GASTROSCHISIS , *OBSTETRICS , *HERNIA - Abstract
Introduction: Gastroschisis represents a congenital malformation of the anterior abdominal wall. It is a defect characterized by protrusion of the abdominal viscera through the fullthickness abdominal defect (peritoneum, muscle, fascia and skin). Diagnosis of gastroschisis can be made as early as the first trimester and routinely in the second trimester by fetal ultrasound. Prenatal diagnosis of gastroschisis is important because it enables rapid and appropriate management both during pregnancy and after delivery. Aim: The aim of this work is a retrospective analysis of fetal gastroschisis diagnosed in the Maternal-Fetal Medicine Centre in the years 1998-2011. Material and methods: The analysis included 35 cases of fetal gastroschisis diagnosed in the Maternal-Fetal Medicine Centre in the years 1998-2011. Results and discussion: The most numerous group of pregnant women, whose fetuses were diagnosed with gastroschisis, were young women below 35 years of age, more frequently residents of rural than urban areas, in most cases primiparas. Herniated contents most often contained small and large intestine. In 60% of fetal gastroschisis no complications were observed during pregnancy. Conclusions: Early diagnosis seems to be of particular importance, as it allows monitoring for potential complications of gastroschisis, which may affect prompt decisions of elective preterm delivery, delivery at a referral center, and hence the possibility of preparing neonatal and pediatric surgical team. [ABSTRACT FROM AUTHOR]
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- 2015
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108. A Chicken Embryo Model for the Study of Umbilical and Supraumbilical Body Wall Malformations.
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Ridderbusch, Ina, Bergholz, Robert, Fattouh, Miriam, Eschenburg, Georg, Roth, Beate, Appl, Birgit, Maenner, Joerg, Reinshagen, Konrad, and Kluth, Dietrich
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CHICKEN embryos , *UMBILICAL cord abnormalities , *SURAMIN , *TRYPAN blue , *ANIMAL models in research - Abstract
Background/Purpose The embryology of ventral body wall malformations is only partially understood, although their incidence is relatively common. As only few experimental data exist on the development of those defects, the aim of our study was to compare the teratogenic effect of trypan blue (TB) and suramin (SA) in their capability to induce umbilical and supraumbilical abdominal wall malformations in a chicken egg model. Materials and Methods A total of 255 fertilized chicken eggs were incubated at 38°C and 75% relative humidity. Embryos were treated in ovo on incubation day 2.5 (Hamburger/Hamilton (HH) stage 13). The eggshell was windowed, and solutions of TB or SA were injected into the coelomic cavity at the region of the umbilicus. The window was closed and the embryos reincubated until examination on day 8 (HH 34). Results A total of 60 embryos survived in each group. The largest number of embryos presented with defects in the umbilical and supraumbilical region (25% in the SA group and 40% in the TB group). A combination of both defects (thoracoabdominoschisis) was seen in 20% of the TB and 8.3% of the SA groups, respectively. Associated anomalies found in both groups were head and eye defects, abnormal pelvic configurations, leg deformities, and mild forms of cloacal exstrophies. Conclusions TB and SA have both a high potential to induce umbilical and supraumbilical ventral body wall malformations in chicken embryos. This novel animal model might help to establish a more profound understanding of the developmental steps in ventral body wall formation and the embryology for its malformations. [ABSTRACT FROM AUTHOR]
- Published
- 2015
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109. Combined therapy of NPWT and bipedicled flap as an alternative approach for giant abdominal wall defect with significant visceral edema: report of a case.
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Yasui, Go, Furukawa, Hiroshi, Warabi, Takehiro, Hayashi, Toshihiko, Oyama, Akihiko, Funayama, Emi, and Yamamoto, Yuhei
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NEGATIVE-pressure wound therapy ,EDEMA ,INTRA-abdominal hypertension ,ABDOMINAL wall ,SURGICAL flaps - Abstract
Open abdomen management is commonly used for the critically injured patients to avoid abdominal compartment syndrome. But it usually continues for days to weeks and finally results in abdominal wall defect that is too wide to close at once. This article presents an alternative approach to close the giant abdominal wall defect by using the combination of bipedicled flaps with the components separation technique and V.A.C.® system. [ABSTRACT FROM PUBLISHER]
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- 2015
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110. Síndrome de Prune Belly: cirugía para mejoría estética y reconstrucción abdominal.
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León-Hernández, M. A., Acosta-León, J., and Cárdenas-Camarena, L.
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Prune Belly Syndrome is a rare congenital disease in which besides the genitourinary manifestations, the abdominal wall is affected in all patients with various degrees of involvement. We present the case of a male with a follow-up of 15 years, during which 2 surgeries were performed in the abdominal wall: the first at age 8 with the Montfort technique, and the last one 14 years afterwards to correct skin folds and abdominal asymmetry, carrying out and abdominoplasty with the Grazer approach to achieve a better containment through a polypropilene mesh and enhancement of abdominal wall aesthetics. There were no complications during the 2 procedures and very satisfactory aesthetic results were obtained. We propose a surgical alternative for those cases in which the first surgery does not resolve wall defects and abdominal aesthetics. [ABSTRACT FROM AUTHOR]
- Published
- 2015
111. Bioengineered acellular dermal matrices for the repair of abdominal wall defects in rats.
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Mohsina, A., Kumar, N., Sharma, A., Mishra, B., Mathew, D., Remya, V., Shrivastava, S., Negi, M., Kritaniya, D., Tamil Mahan, P., Maiti, S., and Singh, K.
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BIOENGINEERING , *RATS , *PEDICLE flaps (Surgery) , *FIBROBLASTS , *XYLAZINE , *KETAMINE , *SUTURES ,ABDOMINAL wall abnormalities - Abstract
Purpose: Acellular grafts can be used as a better substitute for the prosthetic meshes in reconstruction of abdominal wall defect. The purpose of study was to develop bioengineered scaffolds by seeding primary mouse embryo fibroblast cells (p-MEF) on decellularized rabbit skin and to test the efficacy of these scaffolds for the repair of abdominal wall defects in rats. Methods: The study was conducted on 18 clinically healthy adult Wistar rats of either sex. The animals were randomly divided into two equal groups having nine animals in each group. In both the groups a 20 × 20 mm size full thickness muscle defect was created under xylazine and ketamine anaesthesia in the mid-ventral abdominal wall. In group I the defect was repaired with acellular dermal matrix alone and in group II it was repaired with p-MEF seeded dermal matrix. Matrices were implanted by synthetic absorbable suture material (polyglycolic acid) in continuous suture pattern. The efficacy of the bioengineered matrices in the reconstruction of full thickness abdominal wall defects was evaluated. Results: Macroscopic observations revealed that adhesions with skin and abdominal viscera were found to be less in group II as compared to group I. Immunological reactions were reduced in group II. Histopathological observations also revealed that fibroplasia and collagen fiber arrangement was found to be better in group II. No recurrence of hernia was found in both the groups. Conclusion: On the basis of the results bioengineered cell seeded scaffolds were found to be better than non-cell seeded scaffolds for the repair of abdominal wall defects in rats. [ABSTRACT FROM AUTHOR]
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- 2015
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112. Pulmonary Complications of Abdominal Wall Defects.
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Panitch, Howard B.
- Abstract
Summary The abdominal wall is an integral component of the chest wall. Defects in the ventral abdominal wall alter respiratory mechanics and can impair diaphragm function. Congenital abdominal wall defects also are associated with abnormalities in lung growth and development that lead to pulmonary hypoplasia, pulmonary hypertension, and alterations in thoracic cage formation. Although infants with ventral abdominal wall defects can experience life-threatening pulmonary complications, older children typically experience a more benign respiratory course. Studies of lung and chest wall function in older children and adolescents with congenital abdominal wall defects are few; such investigations could provide strategies for improved respiratory performance, avoidance of respiratory morbidity, and enhanced exercise ability for these children. [ABSTRACT FROM AUTHOR]
- Published
- 2015
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113. Pentalogy of Cantrell and anaesthesia: a case report.
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Oosthuizen, Alexis
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ANESTHESIA , *PERICARDIUM ,ABDOMINAL wall abnormalities - Abstract
Pentalogy of Cantrell, a rare congenital thoracoabdominal disruption, consists of a supraumbilical abdominal wall defect, lower sternal defect, agenesis of the anterior portion of the diaphragm, an absence of the diaphragmatic part of the pericardium, and a malformation of the heart, typically as an ectopia cordis. This case report presents a female neonate, 35 weeks post-conception, weighing 2080 g who presented on day four of life for anaesthesia. She had the five anatomical defects characteristic of Pentalogy of Cantrell. [ABSTRACT FROM PUBLISHER]
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- 2017
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114. Pulmonary hypertension in giant omphalocele infants.
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Partridge, Emily A., Hanna, Brian D., Panitch, Howard B., Rintoul, Natalie E., Peranteau, William H., Flake, Alan W., Scott Adzick, N., and Hedrick, Holly L.
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Background Pulmonary hypoplasia has been described in cases of giant omphalocele (GO), although pulmonary hypertension (PH) has not been extensively studied in this disorder. In the present study, we describe rates and severity of PH in GO survivors who underwent standardized prenatal and postnatal care at our institution. Methods A retrospective chart review was performed for all patients in our pulmonary hypoplasia program with a diagnosis of GO. Statistical significance was calculated using Fisher's exact test and Mann–Whitney test ( p < 0.05). Results Fifty-four patients with GO were studied, with PH diagnosed in twenty (37%). No significant differences in gender, gestational ages, birth weight, or Apgar scores were associated with PH. Patients diagnosed with PH were managed with interventions, including high frequency oscillatory ventilation, and nitric oxide. Nine patients required long-term pulmonary vasodilator therapy. PH was associated with increased length of hospital stay ( p < 0.001), duration of mechanical ventilation ( p = 0.008), and requirement for tracheostomy ( p = 0.0032). Overall survival was high (94%), with significantly increased mortality in GO patients with PH ( p = 0.0460). Prenatal imaging demonstrating herniation of the stomach into the defect was significantly associated with PH ( p = 0.0322), with a positive predictive value of 52%. Conclusions In this series, PH was observed in 37% of GO patients. PH represents a significant complication of GO, and management of pulmonary dysfunction is a critical consideration in improving clinical outcomes in these patients. [ABSTRACT FROM AUTHOR]
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- 2014
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115. Abdominal wall defects: Prenatal diagnosis, newborn management, and long-term outcomes.
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Gamba, Piergiorgio and Midrio, Paola
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Omphalocele and gastroschisis represent the most frequent congenital abdominal wall defects a pediatric surgeon is called to treat. There has been an increased reported incidence in the past 10 years mainly due to the diffuse use of prenatal ultrasound. The early detection of these malformations, and related associated anomalies, allows a multidisciplinary counseling and planning of delivery in a center equipped with high-risk pregnancy assistance, pediatric surgery, and neonatology. At present times, closure of defects, even in multiple stages, is always possible as well as management of most of cardiac-, urinary-, and gastrointestinal-associated malformations. The progress, herein discussed, in the care of newborns with abdominal wall defects assures most of them survive and reach adulthood. Some aspects of transition of medical care will also be considered, including fertility and cosmesis. [ABSTRACT FROM AUTHOR]
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- 2014
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116. Perinatal mortality in pregnancies with omphalocele: data from the Chinese national birth defects monitoring network, 1996-2006.
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Kui Deng, Jie Qiu, Li Dai, Ling Yi, Changfei Deng, Yi Mu, and Jun Zhu
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PERINATAL death ,UMBILICAL hernia ,CHINESE people ,HUMAN abnormalities ,ULTRASONIC imaging ,CONFIDENCE intervals ,DIAGNOSIS ,DISEASES - Abstract
Background Previous studies on the mortality rate of omphalocele are limited. The risk of death of nonisolated omphalocele and that of cases of omphalocele that are diagnosed prenatally by ultrasound are unclear. This study aimed to estimate the perinatal mortality of pregnancies with omphalocele. This study also examined the potential risk of death of non-isolated omphalocele and that of cases that are prenatally diagnosed by ultrasound. Methods Data were retrieved from the national birth defects registry in China, for 1996-2006. Multinomial logistic regression was used to calculate the adjusted odds ratios (AORs) and 95% confidence intervals (CIs) between perinatal mortality and selected maternal and fetal characteristics. Results Among 827 cases of omphalocele, 309 (37.4%) cases resulted in termination of pregnancy and stillbirth, and 124 (15.0%) cases resulted in death in the first 7 days after delivery, yielding a perinatal mortality rate of 52.4% (95% CI: 49.0-55.8%). The late fetal death rate (LFDR) of omphalocele that was diagnosed prenatally by ultrasound was 15.91-fold (AOR: 15.91, 95% CI: 10.18-24.87) higher than that of postnatally diagnosed cases. The LFDR of non-isolated omphalocele was 2.64-fold (AOR: 2.64, 95% CI: 1.62-4.29) higher than that of isolated cases. For the early neonatal death rate, neonates with non-isolated omphalocele had a 2.96-fold (AOR: 2.96, 95% CI: 1.82-4.81) higher risk than isolated cases, but the difference between prenatal ultrasound diagnosis and postnatal diagnosis was not significant. Conclusions Selected fetal characteristics are significantly associated with the perinatal risk of death from omphalocele. Our findings suggest that improving pregnancy and delivery care, as well as management for omphalocele are important. [ABSTRACT FROM AUTHOR]
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- 2014
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117. Major abdominal wall defects in the low- and middle-income setting: current status and priorities
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Lofty-John Chukwuemeka Anyanwu, Niyi Ade-Ajayi, and Udo Rolle
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medicine.medical_specialty ,Psychological intervention ,Abdominal wall ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,Infant Mortality ,medicine ,Humans ,030212 general & internal medicine ,Intensive care medicine ,Gastroschisis ,Priority setting ,Omphalocele ,Low- and middle-income countries ,business.industry ,Incidence ,Abdominal Wall ,Infant, Newborn ,Disease Management ,Infant ,Abdominal wall defects ,General Medicine ,High-income countries ,medicine.disease ,medicine.anatomical_structure ,Pediatrics, Perinatology and Child Health ,Health Resources ,Surgery ,Original Article ,Low and middle income ,business ,Hernia, Umbilical - Abstract
Major congenital abdominal wall defects (gastroschisis and omphalocele) may account for up to 21% of emergency neonatal interventions in low- and middle-income countries. In many low- and middle-income countries, the reported mortality of these malformations is 30–100%, while in high-income countries, mortality in infants with major abdominal wall reaches less than 5%. This review highlights the challenges faced in the management of newborns with major congenital abdominal wall defects in the resource-limited setting. Current high-income country best practice is assessed and opportunities for appropriate priority setting and collaborations to improve outcomes are discussed.
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- 2020
118. Treatment of Ruptured Giant Omphalocele and Gastroschisis with Liver Herniation using a Wound Retractor as a Novel Approach
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Nelson, Jana, Wachowiak, Robin, Siekmeyer, Manuela, Knuepfer, Matthias, Thome, Ulrich, Holger, Stepan, and Lacher, Martin
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giant gastroschisis ,abdominal wall defects ,staged surgical repair ,lcsh:RJ1-570 ,lcsh:Surgery ,liver herniation ,Case Report ,lcsh:Pediatrics ,ruptured giant omphalocele ,lcsh:RD1-811 - Abstract
Ruptured giant omphaloceles (GO) and gastroschisis with total liver herniation are rare cases of exceptionally large abdominal wall defects. Many of these children have lethal outcome. The surgical and postsurgical management are complex. We report on two cases treated with staged surgical repair using a wound retractor as a silo. With this technique, the liver and intestines could be reduced into the abdomen with secondary closure of the abdominal cavity within the first 1 to 2 weeks of life.
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- 2020
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119. Defectos de la pared abdominal. Estudio comparativo entre onfalocele y gastrosquisis.
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NAZER H., JULIO, CIFUENTES O., LUCÍA, and AGUILA R., ALFREDO
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Copyright of Revista Chilena de Pediatría is the property of Revista Chilena de Pediatria and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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- 2013
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120. Association of omphalocele and craniorachischisis totalis: The role of three-dimensional ultrasonography with diagnostic features.
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Ülker, Kahraman, Temur, İsmail, Erdoğan, İnanç, Volkan, İslim, Karaca, Mehmet, and Gül, Abdülaziz
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UMBILICAL hernia , *ABDOMINAL wall , *ULTRASONIC imaging , *THREE-dimensional imaging , *NEURAL tube defects , *CHILDBIRTH , *DISEASE incidence , *ANENCEPHALY , *DISEASES - Abstract
Omphalocele is an anterior abdominal wall defect with the herniation of the visceral contents covered by a thin membrane. It is one of the most common malformations of the anterior abdominal wall, with high morbidity and mortality. The incidence of omphalocele is nearly 1 in 5,000 live births. Cranirachischisis totalis is anencephaly with a contiguous spinal defect. The defect occurs with the failure of neural tube to close within 28 days after conception and leads to fetal loss, still birth, or neonatal death. Prenatal diagnostic tool for both anomalies is ultrasound. In most cases two-dimensional conventional ultrasound provides sufficient images for the accurate diagnosis. In this report, we present the association of omphalocele and craniorachischisis with the three-dimensional ultrasonographic and post-abortal findings. [ABSTRACT FROM AUTHOR]
- Published
- 2013
121. Primary fascial closure versus staged closure with silo in patients with gastroschisis: A meta-analysis.
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Kunz, Sarah N., Tieder, Joel S., Whitlock, Kathryn, Jackson, J. Craig, and Avansino, Jeffrey R.
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ABDOMINAL wall abnormalities ,HEALTH outcome assessment ,SYSTEMATIC reviews ,RANDOMIZED controlled trials ,NEONATAL necrotizing enterocolitis ,LENGTH of stay in hospitals ,LONGITUDINAL method ,PATIENTS - Abstract
Abstract: Background/Purpose: Gastroschisis is the most common congenital abdominal wall defect. Despite advances in the surgical closure of gastroschisis, consensus is lacking as to which method results in the best patient outcomes. The purpose of this meta-analysis was to compare short-term outcomes associated with primary fascial closure and staged repair with a silo in patients with gastroschisis. Methods: We reviewed Medline citations, as well as the Cochrane Database of Systematic Reviews, between January 1, 1996 and June 1, 2012. Articles were identified using the search term “gastroschisis” and [(“treatment outcome” or “prognosis”) or randomized controlled trials]. Case reports, reviews, letters, abstracts only, non-English abstracts, and studies that did not address at least one of the outcomes of interest were excluded from the meta-analysis. Two independent reviewers identified relevant articles for final inclusion. A standard data collection form created by the authors was used to extract study information, including study design, patient characteristics, and reported patient outcomes. The data were analyzed using standard meta-analytic techniques. Results: Twenty studies were included in the meta-analysis. In the five studies that selected closure method randomly or as a temporal shift in practice, silo was associated with better outcomes, with a significant reduction in ventilator days (p<0.0001), time to first feed (p=0.04), and infection rates (p=0.03). When all studies were included, primary closure was associated with improved outcomes. Conclusions: Silo closure is associated with better clinical outcomes in the studies with the least selection bias. Larger prospective studies are needed to definitively determine the best closure technique. [Copyright &y& Elsevier]
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- 2013
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122. Operative Langzeitergebnisse nach kongenitalen Bauchwanddefekten
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Simon, S., Kastl, S., Kissler, H., Göppl, M., Carbon, R., Hümmer, H. P., Hartel, W., editor, and Encke, A.
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- 2000
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123. Beckwith-Wiedemann Syndrome, Delayed Abdominal Wall Closure, and Neonatal Intussusception -Case Report and Literature Review.
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Moreira-Pinto, João, Pereira, Joana, Osório, Angélica, Enes, Carlos, and R. Mota, Céu
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BECKWITH-Wiedemann syndrome , *INTUSSUSCEPTION in children , *UMBILICAL hernia , *FETAL ultrasonic imaging , *SYSTEMATIC reviews ,ABDOMINAL wall abnormalities - Abstract
We present the extremely rare case of a male newborn with Beckwith-Wiedemann Syndrome (BWS) presenting as delayed abdominal wall closure and neonatal intussusception. Fetal ultrasound had shown omphalocele that resolved spontaneously. When feeding was attempted, he had various episodes of vomiting. An x-ray showed signs of high bowel obstruction. Jejunal intussusception was found on laparotomy. Enterectomy and primary jejuno-jejunal anastomosis was performed. During post-operative period subtle physical findings became prominent: plain hemangioma, posterior helical indentations, and macroglossia. Cardiac ultrasonography showed a patent foramen oval with small left-to-right shunt. Ultrasonography showed renal hyperplasia. Genetic study showed hypomethylation of DMR2 region of 11p15 chromosome. [ABSTRACT FROM AUTHOR]
- Published
- 2012
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124. Assessment of early pulmonary function abnormalities in giant omphalocele survivors.
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Danzer, Enrico, Hedrick, Holly L., Rintoul, Natalie E., Siegle, Jennifer, Adzick, N. Scott, and Panitch, Howard B.
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PULMONARY function tests ,UMBILICAL hernia ,INFANT diseases ,RESPIRATORY insufficiency ,SPIROMETRY ,BRONCHODILATOR agents ,PLETHYSMOGRAPHY ,LUNG abnormalities - Abstract
Abstract: Purpose: Infants with giant omphalocele (GO) are at increased risk for persistent respiratory insufficiency, yet information regarding the systematic assessment of their lung function is limited. We performed a group of pulmonary function tests (PFTs) including spirometry, fractional lung volume measurements, assessment of bronchodilator responsiveness, and passive respiratory mechanics in GO survivors during infancy and early childhood to evaluate the nature and degree of pulmonary dysfunction. Material and Methods: Between July 2004 and June 2008, 30 consecutive GO survivors were enrolled in our interdisciplinary follow-up program. Forty-seven percent (14/30) underwent PFT during follow-up evaluation using the raised volume rapid thoracic compression technique to measure forced expiratory flows and bronchodilator responsiveness, body plethysmography to calculate lung volumes, and the single breath occlusion technique to measure passive mechanics of the respiratory system. Results: The mean age at PFT assessment was 19.3 ± 19.7 months (range, 1.0-58). Mean forced vital capacity and mean forced expiratory volume in the first 0.5 second were significantly reduced compared with published normative values (P = .03 and P < .01, respectively). Total lung capacity was significantly reduced (P < .001), whereas functional residual capacity, residual volume, and residual volume to total lung capacity ratio were within the normative range (P = .21, P = .34, and P = .48, respectively). Among the 46% who demonstrated significant bronchodilator responsiveness, there were greater increases in the mean percentage changes in flow at 25% to 75% (P = .01), flow at 75% (P < .001), and flow at 85% (P < .001) compared with those participants that did not respond. Specific compliance was reduced, whereas specific conductance increased, compared with published normal results. Conclusions: Abnormalities of pulmonary function in GO survivors include lung volume restriction without airway obstruction, an increased likelihood of airway hyperresponsivness, and reduced respiratory system specific compliance. Early recognition of pulmonary functional impairment in GO survivors could help to develop targeted treatment strategies to reduce the risk of subsequent pulmonary morbidity. [Copyright &y& Elsevier]
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- 2012
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125. Initial experience of double-layer tension free reconstruction of abdominal wall defects with porcine acellular dermal collagen implant and polypropylene mesh.
- Author
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Shaikh, F., Kennedy, T., Kavanagh, E., and Grace, P.
- Abstract
Introduction and aim: Various techniques have been proposed for the repair of abdominal wall defects (AWD) with varying rates of success. Despite the development of new materials and modifications of surgical technique, no single approach has emerged as the optimum way to close large AWD. We report a method for repairing large incisional and recurrent abdominal wall hernias using a double-mesh technique. The defect is closed using an underlay biological implant and an onlay synthetic mesh, which is 'quilted' to the underlying abdominal wall and biological implant. The current study reports our initial experience with this approach in ten consecutive patients operated on for large AWD. Methods: In this prospective observational study the following data were collected: age, gender, previous surgery, co-morbidities, situation and size of the defect, antibiotic therapy, hospital stay, postoperative complications and bacteriology in case of infection. The patients were reviewed at 1, 3 and 6 months, and 1-year postsurgery. Results: Overall all ten AWD of ≥75 cm were reconstructed successfully using the quilting technique. Median age of patients was 61 years (range 47-73 years); male:female ratio was 3:2 and median weight was 107.5 kg. Two patients developed a wound infection and were treated successfully with antibiotics. At median follow-up of 15.5 months (range 6-29 months) there was no case of recurrence. Conclusion: The use of double-layer of porcine acellular dermal collagen implant and polypropylene mesh in reconstruction of AWD can be considered a safe and effective treatment. The early short-term results are encouraging with few complications. [ABSTRACT FROM AUTHOR]
- Published
- 2012
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126. Associated malformations and the “hidden mortality” of gastroschisis.
- Author
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Akhtar, Javed and Skarsgard, Erik D.
- Subjects
FETAL abnormalities ,MORTALITY ,ABORTION ,STILLBIRTH ,AUTOPSY ,CENTRAL nervous system ,MUSCULOSKELETAL system - Abstract
Abstract: Background: Little is known about associated anomalies in fetuses with gastroschisis (GS) who experience an “atypical perinatal event,” defined as spontaneous abortion, stillbirth, termination, or death within 24 hours of birth. Purpose: This study aims to compare associated malformation rates in an atypical perinatal event cohort vs newborns with GS surviving longer than 24 hours. Methods: A national prospective GS database was analyzed for cases with an atypical perinatal event. Associated anomaly rates were compared between this cohort and babies surviving longer than 24 hours. Results: Twenty-three atypical perinatal events (2 spontaneous abortions, 7 stillbirths, 11 terminations, and 3 deaths within 24 hours) were identified from 529 total GS cases. Autopsies in 14 (61%) of 23 identified at least 1 anomaly (excluding intestinal, patent ductus arteriosus, and undescended testicle) in 11 (78.6%) and a “lethal” anomaly in 4 (36%). The associated anomaly rate in newborns surviving longer than 24 hours was 7.3% (37/506; P < .0001). The anomalies in the atypical perinatal event cohort were musculoskeletal (35%), cardiac, central nervous system, pulmonary, and genitourinary (12% each). Among survivors, the most common anomalies were cardiac (38%), genitourinary (32%), musculoskeletal (16%), and central nervous system (8%). Conclusion: Rates of associated anomalies are significantly higher in fetuses experiencing atypical perinatal events and may represent the “hidden mortality” of GS. [Copyright &y& Elsevier]
- Published
- 2012
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127. Surgical treatment of parietal defects with "da Vinci" surgical robot.
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Vasilescu, D. and Paun, S.
- Subjects
- *
MILITARY medicine , *PARIETAL lobe injuries , *TELEMEDICINE , *SURGICAL robots , *ENDOSCOPIC surgery - Abstract
The robotic surgery has come through the development of telemedicine and minimally invasive surgery concepts, being developed in the military medicine by NASA during the years 1970-1980. The purpose of this paper is to briefly present our experience in the new field of the robotic surgery, by analyzing the results obtained over a lot of 20 patients operated with the "da Vinci" robot within the last 5 years in the Clinical Emergency Hospital Bucharest for various abdominal defects. [ABSTRACT FROM AUTHOR]
- Published
- 2012
128. The jury is still out: changes in gastroschisis management over the last decade are associated with both benefits and shortcomings.
- Author
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Weil, Brent R., Leys, Charles M., and Rescorla, Frederick J.
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INTENSIVE care units ,PATIENT safety ,GENETIC disorders ,POSTOPERATIVE care ,SURGICAL site infections ,HEALTH outcome assessment ,PRIMARY care - Abstract
Abstract: Purpose: Management of gastroschisis has shifted from early primary closure to preformed silo placement and delayed closure. We aimed to identify how closure techniques have changed and how outcomes have been affected. Methods: Records of patients undergoing gastroschisis closure at a single institution from 2000 to 2009 were reviewed. Patient characteristics and outcomes were collected and compared among those undergoing primary closure vs preformed silo placement. Outcomes were also compared in an era when primary closure predominated (2000-2002) vs one when primary silo predominated (2003-2009). Results: From 2000 to 2009, 203 patients underwent gastroschisis closure. Primary closure was performed in 50% of patients from 2000 to 2002 vs 12.3% from 2003 to 2009. Preformed silos were placed in 34.7% of patients from 2000 to 2002 vs 84.4% from 2003 to 2009. Patients treated from 2000 to 2002 experienced shorter hospital stays and shorter time to achievement of full enteral nutrition. Patients treated from 2003 to 2009 developed fewer ventral hernias and wound infections and required less ventilator days. Patients undergoing early primary closure developed ventral hernias at higher rates compared with those treated with preformed silos. Intensive care unit stay was longer for patients receiving preformed silos. Conclusion: Change in our management strategy has resulted in prolonged intensive care unit stay and time to full feeds but reduced postoperative hernias and wound infections. [Copyright &y& Elsevier]
- Published
- 2012
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129. Fetal Gastroschisis: Epidemiological Characteristics and Pregnancy Outcomes in Mississippi.
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Tam Tam, Kiran B., Briery, Christian, Penman, Alan D., Bufkin, Laura, and Bofill, James A.
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ANALYSIS of variance , *CHI-squared test , *GASTROINTESTINAL diseases , *NEONATAL diseases , *EVALUATION of medical care , *POISSON distribution , *PREGNANCY , *REGRESSION analysis , *SEPSIS , *U-statistics , *LOGISTIC regression analysis , *DISEASE incidence , *GASTROINTESTINAL system abnormalities , *RETROSPECTIVE studies , *DATA analysis software - Abstract
We describe the epidemiological characteristics and identify maternal-fetal outcomes in pregnancies complicated by gastroschisis. We retrospectively reviewed 115 cases of gastroschisis at the University of Mississippi Medical Center. The incidence of gastroschisis trended upward between 2000 and 2008. Significant proportions of mothers were nonobese, nulliparous, teenagers, smokers, and nonconsumers of alcohol. Infants delivered at >36 weeks or without sepsis had shorter hospital stay (HS) and interval to full enteral feeding (FEF). The rates of low birth weight (LBW), fetal growth restriction, and spontaneous preterm birth (PTB) were 63%, 45%, and 24%, respectively. Bowel atresia was noted in 9%. Rates of primary closure (25%), neonatal sepsis (29%), fetal death (2%), and infant mortality (4%) were notable. Median HS and interval to FEF were 40 and 30 days, respectively. The incidence of gastroschisis is increasing in Mississippi. Sepsis, LBW, and PTB are key determinants of poor infant outcomes. [ABSTRACT FROM AUTHOR]
- Published
- 2011
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130. Challenges and outcomes of management of anterior abdominal wall defects in a Nigerian tertiary hospital.
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Abdur-Rahman, Lukman O., Abdulrasheed, Nasir A., and Adeniran, James O.
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HUMAN abnormalities , *UMBILICAL hernia , *PREGNANCY complications , *ULTRASONIC imaging , *SEPSIS , *MEDICAL statistics , *HEALTH outcome assessment , *INFANT health - Abstract
Background: Abdominal wall defect presents a great challenge when it is large, ruptured, or associated with other anomalies. Objective: To review the challenges and outcome of management of anterior abdominal wall defects (AAWD). Materials and Methods: A retrospective review of omphalocele and gastroschisis managed over 8 years at our institution. Results: Omphalocele (n=49) and gastroschisis (n=7) constituted 2.4% of total admission. The median age was 23.5 hours, with male-female ratio of 1:1.1. Term infants were 91.7% and more than 75% weighed above 2.5 kg. The mean maternal age was 28.5±5.87 years and mean parity was 3.1±2.0, with P values of 0.318 and 0.768, respectively. More than 92.9% of infants were out-born, 46 pregnancies (82.1%) were booked, and 51 (91.1%) had at least one ultrasound scan, but only 1 (1.8%) was diagnosed with gastroschisis. Ruptured omphalocele were 11 (6 major, 5 minor) in number, 3 of which presented with enterocutaneous fi stula, and 3 (6.1%) were syndromic omphalocele. Positive blood culture confi rmed septicaemia in 21 cases (37.5%). Surgical repair was done in 35 cases (62.5%), 44.6% as emergency, and 17.9% as elective. Non-operative management was done in 21 patients (37.5%) and 5 (8.9%) were discharged against medical advice. Median length of hospital stay was 10 days (mean, 15.98±14.38). Postoperative complication rate was 32.1% and overall mortality was 30.4%, with the highest case fatality among gastroschisis (57.1%) and omphalocele major (32.1%). Conclusions: There were large numbers of out-born infants due to poor prenatal diagnosis in spite of high instances of antenatal ultrasound scan. Many patients presented with complications that resulted in poor outcome. [ABSTRACT FROM AUTHOR]
- Published
- 2011
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131. Review of the evidence on the closure of abdominal wall defects.
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Mortellaro, Vincent, Peter, Shawn, Fike, Frankie, Islam, Saleem, Mortellaro, Vincent E, St Peter, Shawn D, and Fike, Frankie B
- Subjects
- *
UMBILICAL hernia , *GENETIC disorders , *STOMACH surgery , *OPERATIVE surgery , *PEDIATRIC surgery , *PEDIATRICS , *ABDOMINAL surgery , *ABDOMINAL abnormalities , *MULTIPLE human abnormalities , *PRENATAL diagnosis , *EVIDENCE-based medicine , *DIAGNOSIS , *GASTROSCHISIS , *SURGERY ,ABDOMINAL wall abnormalities - Abstract
Infants with congenital abdominal wall defects pose an interesting and challenging management issue for surgeons. We attempt to review the literature to define the current treatment modalities and their application in practice. In gastroschisis, the overall strategies for repair include immediate closure or delayed operative repair. The best level of data for gastroschisis is grade C and appears to support that there is no major difference in survival between immediate closure or delayed repair. In patients with omphalocele, the management techniques are more varied consisting of immediate closure, staged closure or delayed closure after epithelialization. The literature is less clear on when to use one technique over the other, consisting of mostly grade D and E data. In patients with omphalocele, a registry to collect information on patients with larger defects may help determine which of the management strategies is optimal. [ABSTRACT FROM AUTHOR]
- Published
- 2011
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132. Prenatální diagnostika vrozených vad v České republice -- aktuální data.
- Author
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GREGOR, V., ŠÍPEK, A., HORÁČEK, J., ŠÍPEK Jr., A., and LANGHAMMER, P.
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- *
HUMAN abnormalities , *ANENCEPHALY , *SPINA bifida , *DOWN syndrome , *FIRST trimester of pregnancy - Abstract
A retrospective data analysis on prenatal diagnostics efficiency of selected types of birth defects in the Czech Republic. Incidences of selected both pre- and postnataly diagnosed defects in the Czech Republic in 2008 were processed and compared to corresponding data from 1994-2007 period. In prenatal diagnostics a number of operations performed has been increasing and influencing incidences of some defects in births accordingly. Incidences in primarily severe defects in births has decreased significantly (anencephaly, spina bifida, abdominal wall defects), in others (Down syndrome) has decreased less significantly and in those defects which are not diagnosticable prenatally at the moment is more or less stable. However, a spectrum of screening methods as well as methods of prenatal diagnostics in use has changed recently which makes their efficiency in some defects increasing and also moves their diagnostics into the first trimester of pregnancy. [ABSTRACT FROM AUTHOR]
- Published
- 2011
133. Outcome Differences Between Gastroschisis Repair Methods
- Author
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McNamara, William F., Hartin, Charles W., Escobar, Mauricio A., and Lee, Yi-Horng
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- *
HEALTH outcome assessment , *ABDOMINAL wall , *GENETIC disorders , *PARENTERAL feeding , *ACIDOSIS , *RETROSPECTIVE studies , *LENGTH of stay in hospitals , *DISEASES - Abstract
Background: Gastroschisis is a congenital abdominal wall defect that is repaired with either a primary closure or staged closure. The outcome of these infants may differ because of different closure techniques. In addition to the usual markers of parenteral nutrition (PN) use and length of stay (LOS) as outcome measures, we examined the duration of postoperative acidosis and positive fluid balance as markers for postoperative stress associated with these two techniques. Methods: A retrospective review of newborns with gastroschisis was conducted at a free-standing children''s hospital from 2002 to 2008. The demographic data, gestational age, birth weight, operative reports, days on PN, LOS, duration of postoperative acidosis and fluid balances were reviewed. Data were analyzed using the Fisher''s exact test or unpaired t test. Results: Thirty-two infants with gastroschisis were identified. One was excluded from analysis due to incomplete follow-up. The patients were classified as either primary closure (n = 8) or staged repair (n = 23). There was one death in our series. Patients who underwent primary closure had significantly older gestational age and higher birth weight. Primary closure is associated with significantly less duration of postoperative metabolic acidosis and fewer days with positive fluid balance. Patients who had primary repair also had less parenteral nutrition use and shorter length of hospitalization, though not statistically significant. Gastroschisis with associated intestinal atresia was more likely to be repaired with staged closures. Conclusions: There are physiologic advantages to primary repair of gastroschisis that can lead to better outcome, but the indications for the choices of closure technique remain unclear. Primary closure should be used when possible. [Copyright &y& Elsevier]
- Published
- 2011
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134. Gastroschisis: a national cohort study to describe contemporary surgical strategies and outcomes.
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Owen, Anthony, Marven, Sean, Johnson, Paul, Kurinczuk, Jennifer, Spark, Patsy, Draper, Elizabeth S., Brocklehurst, Peter, and Knight, Marian
- Subjects
ABDOMINAL wall abnormalities ,SURGICAL therapeutics ,HEALTH outcome assessment ,INFANT diseases ,MEDICAL statistics ,PROGNOSIS ,FOLLOW-up studies (Medicine) - Abstract
Abstract: Background: Information on adoption of newer surgical strategies for gastroschisis and their outcomes is largely limited to hospital-based studies. The aim of this study was to use a new UK national surveillance system to identify cases and thus to describe the contemporary surgical management and outcomes of gastroschisis. Methods: We conducted a national cohort study using the British Association of Paediatric Surgeons Congenital Anomalies Surveillance System to identify cases between October 2006 and March 2008. Results: All 28 surgical units in the United Kingdom and Ireland participated (100%). Data were received for 95% of notified cases of gastroschisis (n = 393). Three hundred thirty-six infants (85.5%) had simple gastroschisis; 45 infants (11.5%) had complex gastroschisis. For 12 infants (3.0%), the type of gastroschisis could not be categorized. Operative primary closure (n = 170, or 51%) and staged closure after a preformed silo (n = 120, or 36%) were the most commonly used intended techniques for simple gastroschisis. Outcomes for infants with complex gastroschisis were significantly poorer than for simple cases, although all deaths occurred in the simple group. Conclusions: This study provides a comprehensive picture of current UK practice in the surgical management of gastroschisis. Further follow-up data will help to elucidate additional prognostic factors and guide future research. [ABSTRACT FROM AUTHOR]
- Published
- 2010
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135. Modified onlay technique for the repair of the more complicated incisional hernias: single-centre evaluation of a large cohort.
- Author
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Poelman, M. M., Langenhorst, B. L. A.M., Schellekens, J. F., and Schreurs, W. H.
- Subjects
- *
HERNIA surgery , *FASCIAE necrosis , *BOWEL obstructions , *SURGERY aesthetics , *COHORT analysis ,ABDOMINAL wall abnormalities ,FASCIAE surgery - Abstract
The repair of incisional hernias remains a challenge for the general surgeon. Indications for surgery are severe bowel obstruction, as well as aesthetic problems. There are various surgical methods to correct these hernias, with varying results. However, the gold standard has not yet been found. Both laparoscopic repair and the component separation technique (CTS) have proven to be acceptable techniques; however, they are not always suitable for resolving the more complicated abdominal wall defects, i.e. after open-abdomen treatment or fascial necrosis. In our hospital, we developed a new onlay technique which we have evaluated in the following research. During a period of 10 years (1996–2007), 101 patients with an incisional hernia were corrected with the new onlay technique. A Marlex mesh of dimensions at least 10 × 20 cm was used, overlapping the fascia by at least 5 cm on each side. This mesh was stapled onto the fascia with skin staples. Of the 101 patients, there were 45 men and 56 women, with a mean age of 55 years. Nine patients died and 13 were lost during follow-up. Of the remaining 79 patients, eight refused to participate. The mean follow-up time was 64 months (normal distribution, standard deviation [SD] 34 months). This cohort of 101 patients was studied retrospectively. Seventy-one of the 101 patients were evaluated at our out-patient clinic. For 24 patients (25%), the operation was for a recurrence after an incisional hernia correction in the past. Twenty-one patients (20%) had an open-abdomen treatment in their medical history. The surgical procedure was technically possible in all patients and the mean operation time was 63 min. The median admission time was 4.5 days (quartiles 3–6.25). The mean follow-up time was 64 months (SD 35 months). A seroma was reported in 27 of 101 patients (27%) and a wound infection in 22 patients (21%), of which seven patients had to be re-operated. Only if a patient was evaluated at our out-patient clinic could reherniation have been scored; this occurred in 11 of 71 patients (16%). This technique is an effective and simple procedure to correct incisional hernias with acceptable complication rates and is feasible even in the more complicated hernias. [ABSTRACT FROM AUTHOR]
- Published
- 2010
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136. The embryologic origin of ventral body wall defects.
- Author
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Sadler, Thomas W.
- Abstract
Ventral body wall defects include ectopia cordis, bladder exstrophy, and the abdominal wall malformations gastroschisis and omphalocele. The etiology of ectopia cordis, gastroschisis, and bladder exstrophy is not known, but they may be linked to abnormalities in the lateral body wall folds responsible for closing the thoracic, abdominal, and pelvic portions of the ventral body wall. These folds form in the fourth week (postfertilization) of development as a combination of the parietal layer of lateral plate mesoderm and overlying ectoderm and must move ventrally to meet in the midline. There are differential rates of cell proliferation in the folds and asymmetries in their movement that may be involved in teratogenic effects of toxic factors. Also, the fusion process between the folds is complex, involving cell-to-cell adhesion, cell migration, and cell reorganization and all of these phenomena may be targets for disruption, leading to malformations. In this regard, closure of the ventral body wall is likened to neural tube closure and involves similar processes. It also encompasses a similar time frame during development, such that most neural tube and ventral body wall defects have their origins during the fourth week of development. Omphalocele is a separate entity whose etiology is known. This defect is attributed to a failure of gut loops to return to the body cavity after their normal physiological herniation into the umbilical cord from the 6th to 10th week of development. Thus, the origin of this defect is completely different from that of the ventral body wall malformations. [Copyright &y& Elsevier]
- Published
- 2010
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137. Health-related quality of life in patients treated for incisional hernia with an onlay technique.
- Author
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Poelman, M. M., Schellekens, J. F., Langenhorst, B. L. A. M., and Schreurs, W. H.
- Subjects
- *
ABDOMINAL surgery , *HERNIA , *ABDOMINAL wall , *RETROSPECTIVE studies , *LAPAROSCOPY , *PATIENTS , *DISEASES - Abstract
An incisional hernia is a frequent complication of abdominal surgery. The repair of incisional hernias comes with a high risk of reherniation and serious complications. With the introduction of mesh repair, recurrence rates have decreased and subsequent clinical outcomes have improved. Whereas further research needs to be done to improve complication rates and recurrence, the focus has now been placed on quality-of-life outcomes in patients undergoing these repairs. The aim of this study was to investigate the long-term health-related quality of life (HRQL) of patients who were treated for incisional hernias using an onlay technique. Over a period of 10 years (1997–2007), 101 patients with an incisional hernia were treated with an onlay marlex mesh, fixed on the fascia with skin staples. Of the 101 patients, there were 45 males and 56 females, and their mean age was 55 years. Nine patients died and 13 were lost during follow-up. Of the remaining 79 patients, eight refused to participate. The mean follow-up time was 64 months (normal distribution, standard deviation [SD] 35 months). The Short Form 36 (SF-36©) and the Karnofsky Performance Status Scale (KPS) and a semi-structured interview were used to measure HRQL. Seventy-one of the 101 patients were evaluated at our out-patient clinic. Twenty-one patients (20%) had an open-abdomen treatment in their medical history. The median admission time was 4.5 days (quartiles 3–6.25). The mean follow-up time was 64 months (SD 35 months). A seroma was reported in 27 of the 101 patients (27%) and a wound infection in 22 patients (21%), of which five patients had to be re-operated. Only if a patient was evaluated at our out-patient clinic could reherniation be scored; this occurred in 11 of 71 patients (16%). The evaluation of HRQL showed equal SF-36© scores for patients treated for an incisional hernia compared to their matched controls. Patients with a history of an open-abdominal treatment did not score significantly lower compared to patients without such a treatment. The median KPS score was 75, indicating that activities could be performed with effort and patients had some signs of disease. HRQL is the same in patients treated for an incisional hernia compared to the matched controls. Therefore, the onlay technique seems to be an acceptable method to repair large incisional hernias. [ABSTRACT FROM AUTHOR]
- Published
- 2010
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138. Abdominal Wall Defects
- Author
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Baert, Albert L., editor
- Published
- 2008
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139. Isolated hypoplasia of abdominal wall muscles associated with fetal ascites.
- Author
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Travan, Laura, Naviglio, Samuele, Cont, Gabriele, Brovedani, Pierpaolo, Davanzo, Riccardo, and Demarini, Sergio
- Abstract
We report the case of an infant born after parvovirus B19-induced fetal hydrops, who presented at birth with bilateral abdominal wall laxity, which was more evident on the flanks. Imaging exams revealed congenital hypoplasia of oblique abdominal muscles not associated with other anatomical abnormalities except for small liver calcifications. We review the medical literature and identify similar cases associated with fetal ascites. We propose that isolated hypoplasia of abdominal wall muscles can be associated with fetal ascites from various causes, and represents a separate condition from prune belly syndrome. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
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140. At the bottom of the differential diagnosis list: unusual causes of pediatric hypertension.
- Author
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Grinsell, Matthew and Norwood, Victoria
- Subjects
- *
HYPERTENSION in children , *RENOVASCULAR hypertension , *PEDIATRIC cardiology , *HUMAN abnormalities , *OBESITY , *MEDICAL research - Abstract
Hypertension affects 1–5% of children and adolescents, and the incidence has been increasing in association with obesity. However, secondary causes of hypertension such as renal parenchymal diseases, congenital abnormalities and renovascular disorders still remain the leading cause of pediatric hypertension, particularly in children under 12 years old. Other less common causes of hypertension in children and adolescents, including immobilization, burns, illicit and prescription drugs, dietary supplements, genetic disorders, and tumors will be addressed in this review. [ABSTRACT FROM AUTHOR]
- Published
- 2009
- Full Text
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141. Abdominal Wall Reconstruction Using Biological Tissue Grafts.
- Author
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BROWN, PATRICIA
- Abstract
Synthetic mesh products have been used to repair abdominal wall defects (eg, hernias) for many years. Biological mesh products are now available as an option when synthetic mesh products are not appropriate. To correctly prepare biological tissue grafts for use in the OR, perioperative nurses must understand the types of grafts available. Biological tissue grafts may be harvested from human, porcine, bovine, or equine hosts and from skin, pericardium, or small intestine submucosa. [ABSTRACT FROM AUTHOR]
- Published
- 2009
- Full Text
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142. UMBILICAL CORD DISRUPTION SEQUENCE CAUSED BY LONG CORD IN TWO UNRELATED INFANTS WITH AMYOPLASIA.
- Author
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Corona-Rivera, J. Román, García-Cruz, Diana, Estrada-Padilla, Sara A., Pérez-Molina, J. Jesús, Villafuerte-Bautista, Marco A., Tavares-Macías, Gerónimo, and Cárdenas-Ruíz-Velasco, J. José
- Subjects
- *
UMBILICAL cord , *INFANT diseases , *GENETIC disorders , *PATIENTS , *LEG , *EXTREMITIES (Anatomy) - Abstract
Encirclement of a fetal body part by the umbilical cord with or without vascular obstruction in either the umbilical cord or the encircled fetal part is considered an umbilical cord loop (UCL). Significant disruption of the encircled fetal parts is recognized as the umbilical cord disruption sequence (UCDS). UCL around fetal parts is an occasional anomaly in infants with amyoplasia. We report on 2 patients with amyoplasia and damage to the fetal limbs caused by UCDS and a long umbilical cord. Patient 1 showed two deep constrictions on the left lower limb caused by UCL with an intact skin and a mild mark of constriction on the left wrist. The umbilical cord in patient 2 produced 5 entanglements around the left thigh which resulted in a deep groove extending down to the femur and also showed an exposed fracture and gangrene of the entire lower limb with an unusual congenital paraumbilical “stoma” that corresponded to the afferent loops of a jejunal atresia. The UCDS in infants with amyoplasia has been associated with short umbilical cords, whereas in patients without congenital contractures, the UCDS or UCL has been related to long umbilical cords. Our observations of UCDS in patients with amyoplasia but with long umbilical cords suggest the influence of both pathogenic factors or the existence of additional mechanisms. Evidence in patient 2 may support a vascular pathogenesis. [ABSTRACT FROM AUTHOR]
- Published
- 2009
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143. Abdominal Wall Defects: Autopsy Findings of Distinct Groups Suggest Different Pathogenetic Mechanisms.
- Author
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Giménez-Scherer, Juan Antonio, Davies, Belinda R., Reséndiz-Morán, Mario A., and Durán-Padilla, Marco A.
- Subjects
PATHOLOGICAL anatomy ,ABDOMINAL wall abnormalities ,UMBILICAL hernia ,BLOOD flow ,PATHOLOGY - Abstract
Central and lateral abdominal wall defects are probably distinct and likely arise from different pathogenetic mechanisms. An autopsy study was done using data from a total of 45 central and lateral abdominal wall defect cases to evaluate if they are indeed separate entities and to suggest possible mechanisms involved in their formation. Central defects were found to be statistically different from lateral defects; malformations that co-existed with central defects were mainly bilateral and internal and also involved ''inferior'' organs in relation to fetal-embryonal blood flow. Patients with lateral defects were more often female, and their coexistent defects were usually unilateral and external, with only 1 defect occurring in an ''inferior'' organ. These results indicate mechanisms of a vascular perfusion deficit for the majority of the central defects and of external disruption for the lateral defects. [ABSTRACT FROM AUTHOR]
- Published
- 2009
- Full Text
- View/download PDF
144. Routine use of a SILASTIC spring-loaded silo for infants with gastroschisis: a multicenter randomized controlled trial.
- Author
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Pastor, Aimee C., Phillips, J. Duncan, Fenton, Stephen J., Meyers, Rebecka L., Lamm, Amy W., Raval, Mehul V., Lehman, Elizabeth, Karp, Tracy B., Wales, Paul W., and Langer, Jacob C.
- Subjects
ABDOMINAL diseases ,ABDOMINAL wall ,INFANT diseases ,RANDOMIZED controlled trials ,DISEASES - Abstract
Abstract: Background: Retrospective studies have suggested that routine use of a preformed silo for infants with gastroschisis may be associated with improved outcomes. We performed a prospective multicenter randomized controlled trial to test this hypothesis. Methods: Eligible infants were randomized to (1) routine bedside placement of a preformed Silastic spring-loaded silo, with gradual reduction and elective abdominal wall closure, or (2) primary closure. Results: There were 27 infants in each group. There was no significant difference between groups with respect to age, weight, sex, Apgar scores, prenatal diagnosis, or mode of delivery. The total number of days on the ventilator was lower in the spring-loaded silo group, although it did not reach statistical significance (3.2 vs 5.3, P = .07). There was no significant difference between groups with respect to length of time on total parenteral nutrition, length of stay, or incidence of sepsis and necrotizing enterocolitis. Conclusion: Routine use of a preformed silo was associated with similar outcomes to primary closure for infants with gastroschisis but with a strong trend toward fewer days on the ventilator. Use of a preformed silo has the advantage of permitting definitive abdominal wall closure in a more elective setting. [Copyright &y& Elsevier]
- Published
- 2008
- Full Text
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145. Gastrosquisis en dos Gemelos Dicigóticos y Prematuros.
- Author
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Fajardo-Ochoa, Francisco and Olivas-Peñuñuri, María Remedios
- Subjects
- *
UMBILICAL cord abnormalities , *HERNIA , *ULTRASONIC imaging , *DISEASES in twins ,ABDOMINAL wall abnormalities - Abstract
Introduction: Gastroschisis is a defect in the abdominal wall causing evisceration of abdominal contents. The defect usually occurs on the right side of the umbilical cord and is never enclosed in a peritoneal sac. Gastroschisis is primary an isolated defect occurring sporadically and having a multifactorial etiology. Cases Report: We reported two dicigotic and premature twins and both affected with gastroschisis. Twin I: Male, with defect of 3x3 cm. of length and parts of stomach, jejunum and colon eviscerated with moderate serositis. Protective silo was placed for gradual reduction of herniated abdominal contents. Definitive closing was after two weeks, discharged well 30 days after admission. Twin II: Male, with defect of 3x3 cm. of length and thin intestine parts eviscerated with mild serositis. Protective silo was placed for gradual reduction of herniated abdominal contents. Definitive closing was after three weeks, discharged well 34 days after admission. Conclusion: Gastroschisis in siblings and particularly in twins is an infrequent event, which can be diagnosed prenatally by ultrasonography, this will allow to an opportune surgical handling and remarkable improvement in survival. [ABSTRACT FROM AUTHOR]
- Published
- 2008
146. Original article: Exomphalos defects : A review of 15 cases.
- Author
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Puri, B and Sreevastava, DK
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UMBILICAL hernia ,OPERATIVE surgery ,ABDOMINAL wall abnormalities ,COMPARTMENT syndrome ,MEDICAL records ,ANESTHETICS ,HEALTH outcome assessment ,RETROSPECTIVE studies - Abstract
Abstract: Background : The outcome after repair of exomphalos defects has improved significantly with refinements in surgical techniques, multidisciplinary management and monitoring of intra-abdominal pressures. Methods : A retrospective study of medical records of 15 cases with omphalocele was done. Results : Antenatal diagnosis was available in six cases. There were eight females and seven males with a mean birth weight of 2.2 kg. Nine babies had associated anomalies. There were nine major (defect size > 5 cm) and six minor defects. Immediate closure in neonatal period was carried out in 12 cases. Urinary bladder pressure (UBP) was measured to assess intra-abdominal pressure in cases where primary closure was difficult. Primary closure was omitted in the event of intravesical pressures exceeding 20 mm Hg (∼ 25 cms of water). Primary surgical closure was possible in five (56%) major cases. Two cases were subjected to silo repair followed by delayed primary closure whereas the other two required a Goretex mesh closure. Three minor defects could be repaired primarily whereas the remaining three were managed conservatively and closed at age of 9 to 12 months. There were no significant anaesthetic complications. Elective postoperative ventilation was required in one baby. There were three deaths at ages five, nine and ten months due to unrelated causes. Conclusion : Satisfactory outcome is possible in cases with exomphalos defects with intra-operative intravesical pressure assessment forming a convenient method for excluding abdominal compartment syndrome. [Copyright &y& Elsevier]
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- 2008
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147. Prenatal detection of pulmonary hypoplasia in giant omphalocele.
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Kamata, Shinkichi, Usui, Noriaki, Sawai, Toshio, Nose, Keisuke, and Fukuzawa, Masahiro
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UMBILICAL hernia , *RESPIRATORY insufficiency , *FETUS , *NEONATAL death , *AUTOPSY , *LUNG abnormalities , *DIFFERENTIAL diagnosis , *FETAL diseases , *FETAL ultrasonic imaging , *LUNGS , *LUNG diseases , *RETROSPECTIVE studies , *MULTIPLE human abnormalities , *DISEASE complications ,RESEARCH evaluation - Abstract
Respiratory insufficiency has sometimes been reported in giant omphalocele. To determine whether ultrasonic fetal lung measurements including lung/thorax transverse area ratio (L/T) and chest/trunk length ratio (C/T) may be useful in predicting associated pulmonary hypoplasia, 28 fetuses with abdominal wall defects between 1991 and 2003 were reviewed. Nine patients with gastroschisis and 19 with omphalocele were classified into three groups. A group with neonatal death and postmortem lung/body weight ratio below 0.012, which was defined as pulmonary hypoplasia (PH group), included two ruptured giant omphaloceles and two giant omphaloceles with intact covering membrane in utero. A group with artificial ventilation more than 3 months, which was defined as prolonged ventilation (PV group), included one ruptured giant omphalocele and three giant omphaloceles with intact covering membrane. Others were defined as ordinary group. In 12 fetuses with giant omphalocele, the evisceration rate of the liver (LER) was measured in the fetal transverse abdominal dimension including the base of the liver. The L/T in PH group was significantly decreased to other groups. The C/T in PH group was significantly increased to ordinary group. There was no significant difference in the LER among three groups. A measurement of L/T may be useful in predicting associated pulmonary hypoplasia in giant omphalocele. However, antenatal detection of patients required prolonged ventilation may be difficult and require further study. [ABSTRACT FROM AUTHOR]
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- 2008
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148. Gastroschisis in the United States 1988–2003: analysis and risk categorization of 4344 patients.
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Abdullah, F., Arnold, M. A., Nabaweesi, R., Fischer, A. C., Colombani, P. M., Anderson, K. D., Lau, H., and Chang, D. C.
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HUMAN abnormalities , *ABDOMINAL wall , *BOWEL obstructions , *INFANTS , *DATABASES , *MORTALITY , *PERINATOLOGY - Abstract
Objective:Gastroschisis is a rare congenital abdominal wall defect through which intraabdominal organs herniate and it requires surgical management soon after birth. The objectives of this study were to profile patient characteristics of this anomaly utilizing data from two large national databases and to validate previous risk stratification categories of infants born with this condition.Methods:An analysis was performed using 13 years of the National Inpatient Sample database (1988–1996, 1998, 1999, 2001, 2002) and 3 years of the Kids' Inpatient Database (1997, 2000, 2003). These combined databases contain information from nearly 93 million discharges in the United States. Infants with gastroschisis were identified by International Classification of Disease-9 procedure code 54.71 (repair of gastroschisis) and an age at admission of <8 days. Variables of gender, race, geographic region, co-existing diagnoses, length of stay, hospital charges adjusted to 2005 dollars, complications and inpatient mortality were collected from the databases. Infants were divided into simple and complex categories based on the absence or presence of intestinal atresia, stenosis, perforation, necrosis or volvulus. Comparisons between groups were performed using Pearson's χ2 for categorical outcomes and the Kruskal–Wallis test for non-normally distributed continuous variables.Results:A total of 4344 infants with gastroschisis were identified. These were comprised of 44.0% female infants (n=1910), 46.4% male infants (n=2017) whereas 9.6% were not reported (n=415). Racial analysis showed the largest subset being white in 40.9% of infants (n=1775) with Hispanic infants being the next highest group reported at 17.2% (n=745). Co-existing intestinal anomalies were the most common, affecting 9.9% (n=429) infants, whereas certain cardiac (6.8%, n=294) and pulmonary (1.7%, n=72) conditions were also identified. Simple gastroschisis represented 89.1% (n=3870) of the group whereas 10.9% (n=474) were complex in nature. Simple and complex patients differed in median length of stay (28 vs 67 days, P<0.01), inpatient mortality (2.9 vs 8.7%, P<0.01) and median inflation-adjusted hospital charges ($90 788 vs $197 871, P<0.01).Conclusions:These data represent a national analysis of the largest group of infants with gastroschisis to date which further aids the characterization and understanding of this serious congenital condition.Journal of Perinatology (2007) 27, 50–55. doi:10.1038/sj.jp.7211616; published online 12 October 2006 [ABSTRACT FROM AUTHOR]
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- 2007
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149. Gastroschisis.
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Lund, Carolyn Houska, Bauer, Kathryn, and Berrios, Margarita
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CASE studies ,NEONATAL diseases ,ABDOMINAL wall ,NEONATAL intensive care ,PRENATAL diagnosis ,DISEASES - Abstract
The article presents a case study of a newborn with gastroschisis, which is a defect of the abdominal wall, generally to the right of the normal insertion of the umbilical cord. It discusses a retrospective analysis of gastroschisis cases admitted in a single tertiary neonatal intensive care unit over a 5-year period in terms of maternal age as well as prenatal diagnosis. It takes into consideration the type of repair, length of stay and complications.
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- 2007
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150. Cardiac axis in fetuses with abdominal wall defects.
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Boulton, S. L., Mkenna, D. S., Cly, G. C., Webb, D. C., Bantz, J., and Sonek, J.
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PREGNANCY complications , *ECTOPIC pregnancy , *ABDOMINAL pregnancy , *ABDOMINAL wall , *CONGENITAL heart disease , *ULTRASONIC imaging - Abstract
Objectives To investigate whether fetal cardiac axis is affected by the presence of an abdominal wall defect (AWD) independent of congenital heart disease (CHD). Methods Video ultrasound records from fetuses with AWDs identified from 1991-2004 were reviewed. Still images of the fetal cardiac four-chamber view were digitized and two independent examiners measured the cardiac axis. A cardiac axis of > 65° or <25° was considered abnormal. Maternal charts were reviewed for fetal echocardiogram results and neonatal charts were reviewed for confirmation of CHD and type of AWD. Results of 17 fetuses with omphalocele and 42 fetuses with gastroschisis, 16 (27%) fetuses had an abnormal cardiac axis, while only seven (12%) had CHD. Fifty-nine percent of fetuses with omphalocele had an abnormal cardiac axis and 35% had CHD. Fourteen percent of fetuses with gastroschisis had an abnormal cardiac axis and 2% had CHD. Of 43 fetuses with a normal cardiac axis, only one had CHD. Conclusions Fetal cardiac axis is often affected by the presence of an A WD independent of CHD. A normal cardiac axis in fetuses with AWDs is an accurate predictor of the absence of CHD, the negative predictive value being 97.7%. [ABSTRACT FROM AUTHOR]
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- 2006
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