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Purpose: Neurodevelopmental disorders (ND) have been recognized as the most common and potentially most disabling outcome of congenital diaphragmatic hernia (CDH). Our aim was to evaluate the incidence of ND in patients with a history of CDH referred for ND assessment on the basis of clinically relevant symptoms rather than through a screening process. Methods: The study was a nationwide, population-based prospective nested case–control study within a cohort of newborn children who survived the newborn period in Sweden during the observational period from 1st January 1982 until 31st December 2015. Results: In the study period, 641 non-syndromic CDH survivors were identified, and 3080 control cases were selected. Significantly higher incidence of clinically relevant any ND (11.5% vs 5.6%,p < 0.001), ASD (3.9% vs 2.1%,p:0.011), and intellectual disorder (6.6% vs 0.7%,p < 0.001) were observed in CDH compared to controls. When compared with controls, those with CDH were found to have a 2.179 times higher risk to develop any ND (p < 0.001), 1.867 times higher risk for ASD (p = 0.008), and 10.63 times higher for intellectual disorder (p < 0.001). Conclusion: CDH survivors have a higher risk of clinically relevant ND than the general population, independent of the effect of screening. [ABSTRACT FROM AUTHOR]

Introduction: While a patent ductus arteriosus (PDA) helps offload the right ventricle in the acute congenital diaphragmatic hernia (CDH)-associated pulmonary hypertension, its role on long-term outcomes in CDH has not been investigated. Our objective was to examine associations of the PDA with long-term clinical outcomes in CDH. Methods: A single-center retrospective descriptive study of 122 CDH patients dichotomized by duration with PDA, as ≤14 versus >14 postnatal days (PND) and ≤30 versus >30 PND. Fisher’s exact test, Wilcoxon rank-sum test, and multiple linear and logistic regression analyses were used for analyses. Results: In unadjusted and adjusted for CDH severity comparisons, patients with PDA >14 PND and >30 PND had a higher risk of death, longer length of stay, mechanical ventilation duration, and need for tracheostomy, diuretics, and PH medications at discharge. Conclusion: A PDA beyond the newborn period is associated with adverse outcomes in infants with CDH. [ABSTRACT FROM AUTHOR]

Congenital diaphragmatic hernia (CDH) is a severe congenital anomaly often accompanied by other structural anomalies and/or neurobehavioral manifestations. Rare de novo protein-coding variants and copy-number variations contribute to CDH in the population. However, most individuals with CDH remain genetically undiagnosed. Here, we perform integrated de novo and common-variant analyses using 1,469 CDH individuals, including 1,064 child-parent trios and 6,133 ancestry-matched, unaffected controls for the genome-wide association study. We identify candidate CDH variants in 15 genes, including eight novel genes, through deleterious de novo variants. We further identify two genomic loci contributing to CDH risk through common variants with similar effect sizes among Europeans and Latinx. Both loci are in putative transcriptional regulatory regions of developmental patterning genes. Estimated heritability in common variants is ∼19%. Strikingly, there is no significant difference in estimated polygenic risk scores between isolated and complex CDH or between individuals harboring deleterious de novo variants and individuals without these variants. The data support a polygenic model as part of the CDH genetic architecture. Congenital diaphragmatic hernia (CDH) is a severe congenital anomaly. Genetic diagnoses are made in ∼30% of people with CDH, but the rest of the cases remain unexplained. We identified rare variants in novel genes and common variants in two loci that support a polygenic model for CDH genetic architecture. [ABSTRACT FROM AUTHOR]

Neonatal surgical emergencies are challenging, often high‐risk procedures for the pediatric anesthesiologist. Though each emergency presents different anesthetic challenges, several error traps exist that are common to all procedures in this patient population. These error traps include errors in surgical timing, airway management, maintenance of normothermia and normoglycemia, and recognition of pharmacologic and physiologic differences. In this narrative review, we will discuss each error trap to aid the clinician in recognizing, planning for, and mitigating adverse events. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusions Few reports have shown Quality‐of‐Life long‐term outcomes in children with congenital diaphragmatic hernia (CDH) who received extracorporeal membrane oxygenation (ECMO) support. We reviewed the short‐ and long‐term outcomes in CDH patients that were supported with ECMO during their neonatal treatment.Telephone interviews of parents of CDH children were performed. The Functional Status Scale (FSS) and the Paediatric Quality of Life Inventory (PedQL, Version 4.0) were completed with the parents. All children with a CDH and supported with ECMO from 2010 to 2023 were included in the study.Twenty children were identified, with two having two ECMO runs. Birth weight was 3.2 kg (median). ECMO support lasted for (median) 13.6 days (range 3.8 to 39). Twelve patients were alive at the time of the survey. The age (median) at time of the interview was 6.3 years (range 1 to 12). The FSS score showed no impairment (FSS score 6) in any domain in eight patients. Two patients had a score of 7, and two patients had a score of 8 and 9, respectively. The PedQL showed a median score 84.5, with a physical health summary score of 92.5 and a psychosocial health summary score of 78.7. The cardiac specific PedQL inventory score was 77.ECMO support for CDH patients is associated with functional and Quality of Life outcomes that are similar to that in other PICU discharge populations. Denying ECMO support to CDH patients on the basis of predicted poor long‐term outcomes does not appear to be justified. [ABSTRACT FROM AUTHOR]

In the past decade, several studies have been reported on the use of 17-4 precipitation-hardened (PH) stainless steel (SS)-based functional prototypes prepared by direct metal laser sintering (DMLS) for implantable applications. But hitherto little has been reported on novel 3D-printed diaphragmatic hernia (DH) solution (as an assembly of 17-4 PH SS and polyvinylidene fluoride (PVDF) composite) for Bubalus bubalis (BB). This study reports a novel 3D-printed DH solution of 17-4 PH SS and PVDF composite for BB. Further, a comparative analysis has been performed for thermal, corrosion (in vitro assessment), morphological, tribological, and mechanical properties) of 3D-printed solution with the natural/usual diaphragm of BB (collected from the cadaver). The study shows that the wear rate of the natural diaphragm was observed as 343.71 mm3/m, which was significantly improved with the use of a novel 3D-printed solution (0.003 mm3/m). The porosity (%) and grain size No. was observed as 30.5%, 4 (before wear), and 31.61%, 1.25 (after wear) (at 5N load, 10 rpm, using 1 µm sandpaper on wear surface) in the case of the natural diaphragm. In the case of the proposed solution, the porosity% and grain size No. (before wear) for 17-4PH SS was observed as 15.91%, and 5, and for PVDF composite porosity% was observed as 27.92% and grain size No. 3.25, whereas for the proposed solution in assembly form (after wear), no change was noticed under similar conditions. The results suggest that the natural diaphragm of BB has a yield strength of 2.13 MPa and a percentage elongation of 61.2%, whereas for 17-4 PH SS yield strength was 540 MPa with a percentage elongation of 25%. As regards the corrosion behavior (in vitro analysis), the proposed solution has a corrosion rate of 0.000311 mm/year, whereas the natural diaphragm has 0.000129 mm/year. [ABSTRACT FROM AUTHOR]

Purpose: The survival rate (SR) for neonates born with congenital diaphragmatic hernia (CDH) remains high. Our aim was to investigate the change in SR in children with CDH over the past decades. Methods: The study was a nationwide, population-based prospective nested case–control study within a cohort of newborn children who was born in Sweden during the observational period from 1st January 1982 to 31st December 2015. Results: In the study period, 4654 (99.6%) control children and 684 children with CDH (70.4%, p < 0.001) were with a survival of 2 years of age. Any patients who were born with CDH had a overall 5.8 times higher chance for not surviving 2 years of age than children without CDH. The SR improved significantly in CDH in the past 3 decades. Significantly higher number of patients were prematurely born in the CDH group than in the controls (23.3 vs 6.1%, p < 0.001). The SR of premature and non-premature born CDH patients has increased significantly over the past 3 decades. Conclusion: The SR of CDH patients were significantly increased in the past 3 decades. The 2-year survival remains 5.8 times higher than those who were not born with CDH. These changes were mainly attributed to the improved SR of premature and non-premature born CDH patients. [ABSTRACT FROM AUTHOR]

Purpose: Amniotic fluid stem cell extracellular vesicles (AFSC-EVs) hold regenerative potential to treat hypoplastic lungs secondary to congenital diaphragmatic hernia (CDH). This study aims to investigate sex-specific differences in pulmonary hypoplasia severity and responses to AFSC-EV administration in an experimental CDH mouse model. Methods: C57BL/6J dams were fed with nitrofen + bisdiamine (left-sided CDH) or olive oil only (control) at embryonic day (E) 8.5. Lungs were dissected (E18.5), grown ex vivo and treated with medium ± AFSC-EVs that were collected via ultracentrifugation and characterized (nanoparticle tracking analysis, electron microscopy, Western blotting). Pulmonary hypoplasia was assessed via mean linear intercept (MLI). Gene and protein expression changes (Cd31, Enos, Il1b, TNFa) were measured via RT-qPCR and immunofluorescence. Pups were genotyped for Sry. Results: Experimental CDH showed a male predominance without sex differences for pulmonary hypoplasia severity, fetal lung vascularization, and inflammation. AFSC-EV administration led to improved lung growth (decreased MLI), improved fetal lung vascularization (increased Cd31 and Enos), and decreased fetal lung inflammation (Il1b, TNFa). There was no sex-specific response to AFSC-EV administration. Conclusion: This study shows sex-independent impaired lung growth, vascularization and fetal lung inflammation in a CDH mouse model. Antenatal administration of AFSC-EVs reverses aspects of pulmonary hypoplasia secondary to CDH independent of the biological sex. [ABSTRACT FROM AUTHOR]

Background: Chilaiditi's sign is an incidental radiographic finding, associated with intestinal disposition located between liver and right diaphragm. It is considered as an acquired rather than a congenital condition and the prevalence ranges from 1.18% to 2.4% according to recent adult retrospective studies. The aspects of this rare entity with regards to a 7-month-old male initially misdiagnosed as diaphragmatic hernia is discussed. Case presentation: A 4-month-old Caucasian male was misdiagnosed with a congenital diaphragmatic hernia owing to previous hospitalization with complaints of respiratory tract infection. On admission 3 months later, he was free of any signs and symptoms of intestinal obstruction or respiratory distress. Thorax computed tomography revealed Chilaiditi's sign. A diagnostic laparoscopy was regarded necessary to evaluate the anatomical details. The most prominent finding was the lack of muscle fibers and almost transparent appearance of the medial aspect of the partially eventrated right hemidiaphragm. Owing to delicate anatomical presentation, diaphragmatic plication was considered hazardous. The patient is doing well and under follow-up. Conclusions: It is obvious that Chilaiditi's sign is not always a completely incidental finding of no consequence, and may indicate an underlying congenital diaphragmatic pathology, clearly defined by laparoscopic evaluation in this case. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives Methods Results Conclusions To evaluate the association of standardized prenatal imaging parameters and immediate neonatal variables with mortality prior to discharge in infants with isolated left congenital diaphragmatic hernia (LCDH), and to compare the performance of ultrasound‐ and magnetic resonance imaging (MRI)‐based severity grading for the prediction of neonatal mortality.This was a retrospective study of infants with prenatally diagnosed isolated LCDH referred to a single tertiary center between 2008 and 2020. Fetuses with right or bilateral congenital diaphragmatic hernia, additional major structural anomaly or known genetic condition, as well as cases that underwent fetal intervention or declined postnatal intervention, were excluded. Ultrasound and MRI images were reviewed retrospectively. Univariable and multivariable analyses were performed, incorporating prenatal and immediate neonatal factors to analyze the association with neonatal mortality prior to discharge, and a prediction calculator was generated. The performance of ultrasound and that of MRI for the prediction of neonatal mortality were compared.Of 253 pregnancies with fetal CDH, 104 met the inclusion criteria, of whom 77 (74%) neonates survived to discharge. Seventy‐five fetuses underwent both prenatal ultrasound and MRI. On multivariable analysis, observed/expected (o/e) lung‐to‐head ratio and o/e total fetal lung volume were associated independently with neonatal death (adjusted odds ratio, 0.89 (95% CI, 0.83–0.95) and 0.90 (95% CI, 0.84–0.97), respectively), whereas liver position was not. There was no significant difference in predictive performance between using ultrasound and MRI together (area under the receiver‐operating‐characteristics curve (AUC), 0.85 (95% CI, 0.76–0.93)) compared with using ultrasound alone (AUC, 0.81 (95% CI, 0.72–0.90); P = 0.19). The addition of neonatal parameters (gestational age at birth and small‐for‐gestational age) did not improve model performance (AUC, 0.87 (95% CI, 0.80–0.95)) compared with the combined ultrasound and MRI model (P = 0.22). There was poor agreement between severity assessment on ultrasound and MRI (Cohen's κ, 0.19). Most discrepancies were seen among cases deemed to be non‐severe on ultrasound and severe on MRI, and outcomes were more consistent with MRI‐based prognostication.In fetuses with prenatally diagnosed isolated LCDH, mortality prediction using standardized ultrasound and MRI measurements performed reasonably well. In cases classified as non‐severe on ultrasound, MRI is recommended, as it may provide more accurate prognostication and assist in the determination of candidacy for fetal intervention. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Background: Congenital diaphragmatic hernia (CDH) is a rare disease that affects the development of the diaphragm, leading to abnormal lung development. Unfortunately, there is no established therapy for CDH. Retinoic acid pathways are implicated in the ethology of CDH and macrophages are known to play a role in repairing organ damage. Methods: We have analyzed the effect of several Toll like receptor (TLR) ligands in the nitrofen-induced CDH model in pregnant rats widely used to study this disease and in the G2-GATA4Cre;Wt1fl/fl CDH genetic mice model. Morphometric and histological studies were carried out. Immune cell infiltration was assayed by immunochemistry and immunofluorescence and retinoic pathway gene expression analyzed in vivo and in vitro in macrophages. Results: We found that administering a single dose of atypical TLR2/4 ligands (CS1 or CS2), 3 days after nitrofen, cured diaphragmatic hernia in 73% of the fetuses and repaired the lesion with complete diaphragm closure being on the other hand nontoxic for the mothers or pups. Moreover, these immunomodulators also improved pulmonary hypoplasia and alveolar maturation and vessel hypertrophy, enhancing pulmonary maturity of fetuses. We also found that CS1 treatment rescued the CDH phenotype in the G2-GATA4Cre;Wt1fl/fl CDH genetic mice model. Only 1 out of 11 mutant embryos showed CDH after CS1 administration, whereas CDH prevalence was 70% in untreated mutant embryos. Mechanistically, CS1 stimulated the infiltration of repairing M2 macrophages (CD206+ and Arg1+) into the damaged diaphragm and reduced T cell infiltration. Additionally, those TLR ligands induced retinol pathway genes, including RBP1, RALDH2, RARα, and RARβ, in the affected lungs and the diaphragm and in macrophages in vitro. Conclusions: Our research has shown that TLR ligand immunomodulators that influence anti-inflammatory macrophage activation can be effective in treating CDH, being nontoxic for the mothers or pups suggesting that those TLR ligands are a promising solution for CDH leading to orphan drug designation for CS1. The immune system of the fetus would be responsible for repairing the damage and closure of the hernia in the diaphragm and enhanced proper lung development after CS1 treatment. [ABSTRACT FROM AUTHOR]

Thoracic hernias encompass the protrusion of thoracic contents through the thorax or intra‐abdominal tissue into the thorax. They can be classified as diaphragmatic hernias – either congenital or acquired; pulmonary hernias – involving tissue protrusion through cervical fascia or intercostal spaces; and mediastinal hernias – including cardiac, intrapericardial and hiatal hernias. Prompt identification and classification of thoracic hernias rely on diagnostic imaging, primarily through computed tomography and magnetic resonance, to identify associated complications. This article comprehensively reviews thoracic hernias and their key imaging features. [ABSTRACT FROM AUTHOR]

Purpose: Improved perioperative care has enhanced survival in children with congenital gastrointestinal conditions and abdominal wall defects (AWD). However, epidemiological and surgical outcomes in developing nations are still scarce. Our aim was to assess the burden and mortality of common congenital gastrointestinal anomalies and AWD in Malaysia, and their influencing factors. Methods: Using the Global PaedSurg study protocol with permission, we performed a prospective cohort study on children presenting for the first time between October 2021 and April 2022 with these conditions: Esophageal atresia (EA), congenital diaphragmatic hernia (CDH), intestinal atresia, gastroschisis, exomphalos, anorectal malformation (ARM) and Hirschsprung's disease. We compared mortality and 30-day outcome data across different geographical regions in Malaysia. Results: There were 228 patients with 242 study conditions (EA n = 28, CDH n = 36, intestinal atresia n = 49, gastroschisis n = 12, exomphalos n = 8, ARM n = 77, Hirschsprung's disease n = 32). Our mortality rate was 8.8%; 60% of these were CDH patients. Factors significantly associated with mortality were CDH diagnosis, central venous access requirement, higher American Society of Anesthesiologists (ASA) score, blood transfusion and ventilation requirement. Conclusion: Diagnosis of CDH is the most important predictor for sepsis on arrival and mortality, therefore measures should be taken for early recognition and aggressive management. [ABSTRACT FROM AUTHOR]

Background: Oxygenation index (OI) is associated with severity of newborn pulmonary hypertension (PH) in congenital diaphragmatic hernia (CDH). Higher OI may indicate worst degree(s) of PH. Objectives: This study reports OI dynamic(s) over the first 72 h of life and its correlation with (1) perioperative morbidity and (2) CDH mortality. Methods: Medical records of inborn CDH babies during 2002–2022 were examined. OI on Days (s) 1–3 and perioperative OI trends were recorded. Operation (primary vs patch repair) and survival rates (%) were studied. Results: Fifty-five CDH newborns (54.5% male: 45.5% female)—mean birth GA 37.5 ± 2.7 wks. had a mean birth weight 2813 ± 684 g with prenatal diagnosis in 32.7% cases. 52/55 (94.5%) were intubated at birth and HFOV deployed in 29 (55.8%). Those requiring HFOV had higher OI on DOL1 (24.8 ± 17 vs 10.3 ± 11.5; p < 0.05), DOL 2 (26.3 ± 22.9 vs 6.7 ± 12.1; p < 0.05) and DOL 3 (21.9 ± 33.8 vs 5.5 ± 9.3; p = 0.04). Operation was undertaken in 36/55 (65.5%). Preoperative mortality group had significant higher OI on DOL 2 (42.1 ± 21.0 vs 14.9 ± 9.3; p = 0.04). CDH defects were—Type A N = 27 (75%), Type B N = 7 (19.4%) and Type C N = 2 (5.6%). Overall mortality was 40% (22/55). Statistically significant OI trends were recorded in non-survival vs. survival groups on DOL 1 (31.6 ± 16.8. vs 10.5 ± 9.0; p < 0.05, DOL 2 (38.1 ± 21.9 vs 6.3 ± 7.1; p < 0.05), and DOL 3 (38.8 ± 39.4; p = 0.012). Conclusions: OI dynamics are highly predictive for accurate monitoring of CDH cardiorespiratory physiology and crucially may guide ventilatory management as well as timing of surgery. [ABSTRACT FROM AUTHOR]

Emanuel Syndrome (ES) is a chromosomal disorder characterised by the presence of an extra copy of chromosome 22, specifically a derivative 22 chromosome, which results from an unbalanced translocation involving chromosomes 11 and 22, due to 3:1 meiotic non disjunction. This leads to the gain of the 11q23-qter and 22pter-q11.2 regions. The syndrome is marked by developmental delay, facial dysmorphism, heart defects, genital abnormalities and renal anomalies. In most cases, one of the parents is a carrier of a balanced translocation, t(11;22). The present case is of a two-month-old male child suffering from failure to thrive and developmental delay, who was found to have a karyotype of 47,XY,+der(22)t(11;22)(q23.3;q11.2)dmat, resulting from a maternal balanced translocation, t(11;22)(q23;q11.2). Molecular cytogenetic testing confirmed the presence of partial trisomy 22q11.2 in the proband. This report presents a case of partial trisomy 22q11.2 resulting from a maternal balanced translocation between the long arms of chromosomes 11 and 22, associated with Congenital Heart Defects (CHD) and Congenital Diaphragmatic Hernia (CDH). Approximately, 11 comparable cases have been reported in the Indian population, with variations in breakpoints observed in some. However, none of these previous cases have identified CDH as a phenotypic feature, making this case particularly noteworthy. [ABSTRACT FROM AUTHOR]

Objective: To evaluate medium‐term self‐reported respiratory and gastrointestinal (GI) outcomes in children with congenital diaphragmatic hernia (CDH). Design: Self‐reported respiratory and GI outcomes correlated with prenatal severity indicators. Setting: Prospective study at three fetal medicine units. Population: Families of children prenatally diagnosed with isolated, left‐sided CDH surviving for >1 year. Methods: Families received validated questionnaires for GI outcomes (Infant Gastroesophageal Reflux Questionnaire Revised, I‐GERQ‐R, for infants aged <2 years, or Paediatric Gastro‐oesophageal Symptom and Quality of Life Questionnaire, PGSQ, for children aged aged 2‐8 years or >9 years) and respiratory outcomes (preschool respiratory outcome questionnaire, for children aged ≤5 years, or the International Study of Asthma and Allergies in Childhood asthma questionnaire, for children aged 6–8 years or ≥9 years). Prenatal data collected from the medical records included lung size (percentage observed/expected lung‐to‐head ratio, O/E LHR %), liver position, fetal endoluminal tracheal occlusion (FETO) gestational age (GA) at delivery, and perinatal data included birthweight, location, patch repair and respiratory support. Main outcome measures: The GI and respiratory scores were correlated with O/E LHR using linear and logistic regression models. Univariate analysis was used to evaluate associations with perinatal variables. Results: We obtained 142 responses from 342 families (representing a response rate of 45%). The baseline characteristics of participants and non‐participants were comparable. No correlations between perinatal variables and respiratory or GI scores were identified. Children aged ≤5 years with lower O/E LHR values reported higher respiratory scores (P = 0.0175); this finding was not reported in older children. Overall, the children who underwent FETO (n = 51) had GI (P = 0.290) and respiratory (P = 0.052) scores that were comparable with those of children who were expectantly managed. Conclusions: Families and children with prenatally diagnosed CDH reported fewer respiratory symptoms with increasing age. There was no correlation between O/E LHR or the use of FETO and self‐reported outcomes. [ABSTRACT FROM AUTHOR]

We report the case of a 32‐year‐old man who developed a giant diaphragmatic hernia following the removal of a left ventricular assist device 4 years prior due to improved cardiac function. Chest radiography revealed an intrathoracic prolapse of the gastrointestinal tract. The patient was diagnosed with a diaphragmatic hernia and a laparoscopy‐assisted repair was performed. A 12 × 8 cm hernia was found intraoperatively on the left diaphragm, and a large portion of the gastrointestinal tract had prolapsed into the thoracic cavity. We attempted to repair the ventromedial defect using mesh; however, it was found to be insufficient. Therefore, we used a left rectus abdominis myocutaneous flap to fill the defect and sutured it to the mesh. A myocutaneous flap could be a useful strategy in cases where complete closure with mesh is difficult. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to elucidate the clinical and demographic profiles, as well as perioperative outcomes, of patients undergoing surgery for non-hiatal diaphragmatic hernias. Additionally, it aims to analyse these outcomes based on the surgical approach employed (transthoracic versus transabdominal). Methods: This retrospective, observational study was conducted at a single center and involved patients diagnosed with non-hiatal diaphragmatic hernia who underwent either emergency or elective surgery between July 2007 and March 2023. Clinical characteristics and perioperative outcomes of these patients were compared using appropriate statistical tests.The research protocol for this observational, retrospective, and comparative study followed the Declaration of Helsinki's ethical requirements. The need for Clinical Research Ethics Committee approval was waived according to our institutional law because the study was a retrospective cohort study based on anonymous data of patients. Informed consent was waived because this study involved the secondary analysis of patient medical records. Additionally, this study followed the STROBE guidelines for reporting observational studies. Results: The analysis included 22 patients being 59.1% men, with median age of 61 years. The predominant clinical presentation was restrictive lung disease (40.9%). The majority of cases (68%) had traumatic aetiology with a median defect size of 4 cm (range of 3–8 cm). Elective surgery was performed in 15 cases (68.1%) and transthoracic approach was employed in 13 patients (54.5%). Postoperative major morbidity reached 27.2% and mortality within 30 days was 9.1%. Emergency surgeries accounted for 44.4% of transabdominal interventions, compared to 23% in the transthoracic subgroup (p = 0.376). There were no statistically significant differences between the transabdominal and trasnthoracic approaches in terms of global postoperative complications (88.8% vs. 84.6%, p = 1), major complications (44.4% vs 15.4%, p = 0.734), mortality (11.1% v 7.6%, p = 1) and recurrence (11.1% vs 7.6%, p = 1). Postoperative stay was significantly shorter in the transthoracic subgroup (6 days vs. 14 days, p = 0.011). Conclusions: Non-hiatal diaphragmatic hernias are characterized by significant postoperative major morbidity and mortality rates, standing at 27.2% and 9.1%, respectively, accompanied by a recurrence rate of 9.1%. Both transthoracic and transabdominal approaches demonstrate comparable short- and long-term outcomes. [ABSTRACT FROM AUTHOR]

Background: Congenital diaphragmatic hernia(CDH) is a rare congenital anomaly characterized by herniation of abdominal contents into thoracic cavity through a defect in diaphragm. While commonly diagnosed prenatally or in neonatal period, late-presenting CDH can occur and may mimic other thoracic emergencies such as tension pneumothorax, complicating diagnosis and management. Case presentation: A two-year old male black child from Ethiopia presented to the emergency department with sudden onset of acute respiratory distress. Initial clinical assessment and chest radiography suggested a diagnosis of tension pneumothorax due to the presence of significant mediastinal shift and apparent pleural air. Despite insertion of chest tube, the child's condition did not improve, raising suspicion of alternative diagnosis. Careful observation of initial chest x-ray and subsequent chest ultrasound revealed a left sided congenital diaphragmatic hernia with herniation of stomach and intestine into thoracic cavity compressing the left lung and causing mediastinal shift. After the diagnosis of CDH was confirmed, the child was stabilized and emergent surgical repair performed. Postoperative recovery was uneventful, and the child was discharged with no significant long-term complications. Conclusion: This case underscores the importance of considering CDH in the differential diagnosis of acute respiratory distress in a child. It highlights the diagnostic challenges and potential risks of emergency interventions based on initial misdiagnosis. Even if x -ray looks like typical of tension pneumothorax, it showed giant cystic air filled structure pushing the mediastinal structure to contralateral side with loss of left diaphragmatic outline which raised suspicion of congenital cystic lung mass or congenital diaphragmatic hernia. Advanced imaging and high index of suspicion are crucial for accurate diagnosis and timely management, ultimately improving patient outcomes. Consideration of alternative diagnosis when our initial intervention with insertion of chest tube fail to provide symptom improvement in suspected pneumothorax should raise suspicion of congenital diaphragmatic hernia like in our case. [ABSTRACT FROM AUTHOR]

Purpose: Congenital diaphragmatic hernia (CDH) and cleft lip and/or palate (CL/P) are inborn closure defects. Genetic factors in and outcomes for patients with both anomalies (CDH+CL/P) remain unclear. We aimed to investigate associated genetic aberrations, prevalence of, and outcomes for, CDH+CL/P. Methods: Data from Congenital Diaphragmatic Hernia Study Group (CDHSG) registry were collected. CL/P prevalence in CDH patients was determined. Genetic abnormalities and additional malformations in CDH+CL/P were explored. Patient characteristics and outcomes were compared between CDH+CL/P and isolated CDH (CDH−) using Fisher's Exact Test for categorical, and t-test or Mann–Whitney U-test for continuous, data. p < 0.05 was considered statistically significant. Results: Genetic anomalies in CDH+CL/P included trisomy 13, 8p23.1 deletion, and Wolf-Hirschhorn syndrome (4p16.3 deletion). CL/P prevalence in CDH was 0.7%. CDH+CL/P had lower survival rates than CDH−, a nearly fourfold risk of death within 7 days, were less supported with extracorporeal life support (ECLS), had higher non-repair rates, and survivors had longer length of hospital stay. Conclusion: Genetic anomalies, e.g. trisomy 13, 8p23.1 deletion, and Wolf-Hirschhorn syndrome, are seen in patients with the combination of CDH and orofacial clefts. CL/P in CDH patients is rare and associated with poorer outcomes compared to CDH−, influenced by goals of care decision-making. [ABSTRACT FROM AUTHOR]

Background: Interventional therapies for severe pulmonary arterial hypertension (PAH) can provide right ventricular (RV) decompression and preserve cardiac output. Transcatheter stent placement in a residual ductus arteriosus (PDA) is one potentially effective option in critically ill infants and young children with PAH. We sought to assess recovery of RV function by echocardiographic strain in infants and young children following PDA stenting for acute PAH. Methods: Retrospective review of patients < 2 years old who underwent PDA stenting for acute PAH. Clinical data were abstracted from the electronic medical record. RV strain (both total and free wall components) was assessed from echocardiographic images at baseline and 3, 6, and 12 months post-intervention, as well as at last echocardiogram. Results: Nine patients underwent attempted ductal stenting for PAH. The median age at intervention was 38 days and median weight 3.7 kg. One-third (3of 9) of patients had PAH associated with a congenital diaphragmatic hernia. PDA stents were successfully deployed in eight patients. Mean RV total strain was − 14.9 ± 5.6% at baseline and improved to − 23.8 ± 2.2% at 6 months post-procedure (p < 0.001). Mean free wall RV strain was − 19.5 ± 5.4% at baseline and improved to − 27.7 ± 4.1% at 6 months (p = 0.002). Five patients survived to discharge, and four patients survived 1 year post-discharge. Conclusion: PDA stenting for severe, acute PAH can improve RV function as assessed by strain echocardiography. The quantitative improvement is more prominent in the first 6 months post-procedure and stabilizes thereafter. [ABSTRACT FROM AUTHOR]

Objectives We conducted a meta-analysis of trials to determine the optimal time to conduct surgery for congenital diaphragmatic hernia (CDH) in infants, on or after weaning from extracorporeal membrane oxygenation (ECMO). Methods We searched the PubMed, Embase, Scopus, and Cochrane Library databases to identify relevant articles published prior to May 2023 in which surgery was performed to treat CDH in infants. Data were collected, and continuous data were represented by the mean difference (MD) and 95% confidence interval (CI). Dichotomous data were represented by the odds ratio (OR) and 95% CI. Review Manager V.5.4 and Stata were used to synthesize results and to assess publication bias. Results The results showed that infants undergoing surgery after being weaned from ECMO had reduced mortality (OR, 2.40; 95% CI, 1.23–4.69; p = 0.01) and postoperative bleeding rates (OR, 16.20; 95% CI, 5.73–45.76; p < 0.00001) and reduced ECMO duration (MD, 3.47; 95% CI, 1.89–5.05; p < 0.0001) compared with those who underwent surgery while on ECMO. There was no statistically significant difference in hospital duration (MD, 5.48; 95% CI, −8.66 to 19.62; p = 0.45) or ventilator duration (MD, −1.93; 95% CI, −8.55 to 4.68; p = 0.57). Conclusion We recommend weaning patients with CDH from ECMO before performing surgery. [ABSTRACT FROM AUTHOR]

Background: Thoracic endometriosis syndrome gives rise to various clinical and radiological manifestations. We reviewed the records of patients operated for intrathoracic migration of abdominal viscera through a diaphragmatic hernia secondary to thoracic endometriosis. Methods: We retrospectively reviewed the single-center prospective collected database of all patients operated for thoracic endometriosis during the twenty years. All cases in which an abdominal organ was found to be herniated into the thoracic cavity were retrieved. Clinical and pathological data are presented and analyzed. Results: Twenty women of median age 36 (range 25–58) years were operated for endometriosis-related diaphragmatic hernia. The hernia was diagnosed concomitantly with endometriosis-related pneumothorax in 13 cases and during the exploration of catamenial thoracic pain in seven cases. There were 18 cases on the right side and two cases on the left side. The median diameter of the hernia was 8 cm (2.5–20 cm). In seventeen cases, the hernia was repaired by direct suture, and in three cases a heterologous prosthesis was positioned. At follow-up, two patients had an episode of recurrent pneumothorax. Conclusions: Diaphragmatic hernia should be ruled out in the presence of endometriosis-related pneumothorax or catamenial thoracic pain. Surgery is indicated to make a pathological diagnosis, restore anatomy, and prevent recurrence in patients presenting with pneumothorax. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Veterinary Journal / Revue Vétérinaire Canadienne is the property of Canadian Veterinary Medical Association 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.)

Copyright of Canadian Veterinary Journal / Revue Vétérinaire Canadienne is the property of Canadian Veterinary Medical Association 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.)

Purpose of review: Congenital diaphragmatic hernia (CDH) remains a significant challenge, particularly in severe cases with persistent pulmonary hypertension (PPHN) and hypoplastic lungs and heart. For patients unresponsive to conventional therapies, ECMO is required. While the surgical repair is relatively simple, determining the optimal timing for surgery in patients requiring ECMO is particularly challenging. This review explores the dilemma of surgical timing and proposes a two-staged approach: a reduction in herniated organs and the creation of a silo to relieve abdominal pressure before initiating ECMO, with defect closure following ECMO decannulation. Recent Findings: Studies support pre-, on-, and post-ECMO repair, each with its own risks and benefits. Pre-ECMO repair may enhance ECMO efficacy by relieving organ compression but poses risks due to instability. Post-ECMO repair is safer but may result in losing the chance to repair. On-ECMO repair has significant hemorrhage risks, but early repair with careful anticoagulation management is currently recommended. Recently, the author reported a successful case using a two-staged approach—reducing herniated organs and creating a silo before ECMO, followed by defect closure after ECMO decannulation—which suggests a potential alternative strategy for managing severe CDH. Summary: A two-staged approach may offer a solution for severe CDH patients requiring ECMO. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusions To characterise the feeding profile and care pathway for infants receiving prolonged high‐flow nasal cannula (HFNC) respiratory support for management of a chronic condition at one facility from January to December 2021.Data regarding medical history, HFNC admission details (reason for HFNC, HFNC duration, flow rate), feeding outcomes and speech pathology care were collected from electronic records of HFNC‐dependent infants (requiring HFNC ≥2–3 L/kg for ≥5 consecutive days). Infants with acute respiratory conditions (e.g. bronchiolitis) were excluded.This study included 24 participants (median corrected age at admission 5.3 weeks, range −6 to 18.6). Of these, 15 (60%) had a condition/s that affected more than one body system (e.g. congenital diaphragmatic hernia), requiring the care of multiple specialities. Median length of HFNC use was 37.5 days (range 11–188). Twenty (83.3%) infants were referred for speech pathology (SLP) input while on HFNC support. For those referred, frequency of SLP input was variable (0–3 sessions/week), and HFNC support requirements were the most common barrier to SLP intervention (n = 9, 45%). Twelve (54.5%) infants demonstrated improvement in their primary feeding method by discharge; however, only two (9.1%) infants were discharged on full oral feeds.This study demonstrates variability in oral feeding management in infants with prolonged HFNC‐dependence at our centre. Respiratory support with HFNC was identified as a barrier to progressing oral feeding. Further research is required to determine if oral feeding can be safely undertaken in this cohort. This is imperative to ensure that long‐term feeding outcomes are not negatively impacted by current practice. [ABSTRACT FROM AUTHOR]

To establish normal reference ranges for fetal right ventricular modified myocardial performance index (RV Mod-MPI) using automatic synchronization of the RV inflow and outflow images (MPI+TM). Additionally, we aimed to clinically apply RV Mod-MPI to investigate its changes in fetal right congenital diaphragmatic hernia (CDH) compared to normal fetuses. This prospective study included uncomplicated singleton pregnancies between 16 and 38 weeks of gestational age. Cases with any maternal or fetal complications that developed during the enrollment period were excluded. Two experienced operators measured the RV Mod-MPI using the automated and manual methods. The intraclass correlation coefficients (ICC) were calculated for intra- and inter-operator reproducibility. The mean differences between the manual and automated measurements were also compared. The RV Mod-MPI was then compared between the right CDH fetuses and normal fetuses. Seventy normal fetuses were analyzed for the feasibility of an automated system, and 364 examinations from 272 fetuses were analyzed for developing the normal references. The automated system showed significantly higher intra- and inter-operator reproducibility of Mod-MPI than those of manual measurements (ICC = 0.962 vs. 0.913 and 0.961 vs. 0.889, respectively). The mean difference in Mod-MPI between the manual and automated method was 0.0002 ± 0.0586 with a 95% confidence interval of -0.0095–0.0099. The Mod-MPI and isovolumetric relaxation time increased throughout the gestational weeks. The isovolumetric contraction time increased until 24 weeks of gestation and then slightly decreased afterwards, and the ejection time also increased until 31 weeks of gestation and then decreased. There was no significant difference in the Mod-MPI between right CDH and normal fetuses. The automated system showed high inter- and intra-operator reproducibility. Furthermore, the normal reference values of Mod-MPI for each gestational age were established. Our results suggest that the automated system might be clinically feasible for evaluating fetal cardiac function. [ABSTRACT FROM AUTHOR]

Background: Malrotation is a congenital condition that predisposes individuals to midgut volvulus, which can result in significant bowel resection. While most cases of malrotation are diagnosed by the age of 1 year, typically presenting with symptoms related to volvulus or bowel obstruction, some cases remain asymptomatic. In children with visceral malposition, gastroschisis, omphalocele, or diaphragmatic hernia, malrotation may be suspected before symptoms manifest. However, isolated malrotation without midgut volvulus diagnosed prenatally is rare. We herein present a case of isolated malrotation without midgut volvulus that was prenatally diagnosed and successfully treated with laparoscopic surgery. Case presentation: A 30-year-old woman (gravida 3, para 1) underwent routine obstetric ultrasound, which revealed increased blood flow in the lower uterine segment and abnormal placental attachment. To rule out placenta percreta, magnetic resonance imaging was performed at 34 weeks of gestation. Incidentally, abnormal fetal intestinal arrangement was noted, with the colon localized in the left hemi-abdomen and the small intestine distributed in the right hemi-abdomen, raising suspicion of malrotation. Postnatal contrast studies confirmed the diagnosis of malrotation without midgut volvulus. Given the risk of midgut volvulus, a laparoscopic Ladd's procedure was performed on day 6 of life. The postoperative course was uneventful, and the patient was still symptom-free 1 year postoperatively. Conclusions: This case illustrates that malrotation can be prenatally diagnosed using fetal magnetic resonance imaging. Considering the risk of midgut volvulus, prophylactic Ladd's procedure should be performed in neonatal period. In cases where malrotation is not complicated by midgut volvulus, a laparoscopic Ladd procedure can be safely performed in neonates. [ABSTRACT FROM AUTHOR]

The syndrome of anterior fibroneural stalk, vertebral anomaly, enteric duplication cyst, and diaphragmatic hernia is a manifestation of abnormal notochordal development due to persistence of the neurenteric canal beyond early fetal gestational age. Our description of the third such published case to date supports this novel tetralogy and further illustrates the role of both pre- and postnatal imaging in achieving the diagnosis. [ABSTRACT FROM AUTHOR]

Background/aim: We aimed to compare the results of open surgery and double-port laparoscopic-assisted extracorporeal suturing repair for the treatment of Morgagni hernia (MH). Materials and methods: Twenty-two patients with MH who were operated on in our clinic between January 2012 and January 2023 were included in the study. Patients were divided into two groups according to the surgical technique: open surgery (OS) (n = 14) or laparoscopic surgery (LS) (n = 8). Retrospective comparisons were made between the groups' demographic information, surgical method used, defect size, operation time, length of hospital stay, costs, postoperative problems, and recurrence. Results: There were no statistically significant differences between the groups regarding sex, defect size, or costs. The mean age of the patients in the LS group (101 ± 68.3 months) was significantly higher than that of the OS group (23 ± 18.2 months) (p = 0.005). The operation time of the LS group (33.8 ± 3.6 min) was significantly shorter than that of the OS group (50.8 ± 6.5 min) (p < 0.01). Moreover, the LS group's mean length of hospitalization (1.6 ± 0.9 days) was significantly lower than that of the OS group (2.8 ± 0.7 days) (p = 0.027). Conclusion: Double-port laparoscopic-assisted extracorporeal suturing repair is a reliable technique preferred over open surgical repair due to its shorter operative time and hospital stay, ease of application, better cosmetic results, and no cost difference. [ABSTRACT FROM AUTHOR]

Wandering spleen (WS) is a rare condition often linked with torsion or infarction, but its association with Bochdalek hernia, acute appendicitis, and thrombocytopenia is exceptionally rare. We present a case of a nine-year-old girl who was admitted with acute abdominal pain, later diagnosed with WS, Bochdalek hernia, and acute appendicitis. A literature search was performed on PubMed and Google Scholar on 30 May 2024 with keywords including "Wandering spleen" and ("Bochdalek Hernia" OR "Sepsis" OR "Acute Appendicitis" OR "Thrombocytopenia"). The management was complicated by severe thrombocytopenia and post-operative sepsis, with Klebsiella pneumoniae as the causative agent. Imaging revealed an abnormally located spleen and significant splenic enlargement over time. The patient's condition was managed non-operatively concerning the WS, avoiding splenectomy due to the risks of post-splenectomy sepsis. Instead, laparotomy was performed to address the appendicitis and diaphragmatic hernia. The patient experienced post-operative complications, including a seizure and persistent fever, which resolved with appropriate antibiotic therapy. This case underscores the complexity of managing WS with concurrent severe conditions, highlighting the importance of individualised treatment strategies. It also emphasises the need for further studies to explore optimal treatment modalities for such rare and complex presentations. This case serves as an educational example in clinical settings, demonstrating the challenges and considerations when treating multiple rare pathologies simultaneously. [ABSTRACT FROM AUTHOR]

Traditionally, gestational age <34 wk and weight <2 kg are considered relative contraindications to extracorporeal membrane oxygenation (ECMO). There is a paucity of information that explains the outcomes in this unique population of premature neonates. The purpose of this study is to examine outcomes of patients who undergo ECMO at <34 wk at a single institution. A single-center retrospective review was performed for neonates managed with ECMO in the neonatal intensive care unit from January 2012 to April 2022. Characteristics and outcome data were collected. The primary outcome studied was survival at discharge. Secondary outcomes were intraventricular hemorrhage, ischemic brain injury, and thrombosis. Data were analyzed with descriptive statistics. Following exclusion, 107 patients were included with eight having initiating ECMO at <34 wk. Three (38%) patients, who received ECMO at <34 wk, incurred intraventricular hemorrhages compared to 14 (14%) in the ≥34-wk cohort. Two (25%), who underwent ECMO at <34 wk, exhibited signs of brain ischemia on imaging compared to 9 (9%) in those ≥34 wk, and 3 (38%) patients <34 wk experienced thrombosis compared to 31 (31%) in the ≥34-wk cohort. Five (63%) of those in the <34-wk cohort survived to discharge, similar to 61 (61%) in the ≥34 wk cohort. Our data suggest that EGA <34 wk may not be a contraindication for ECMO, with appropriate counseling of potential risks. • ECMO at <34 wk cohort experienced IVH and thrombosis. • Survival after ECMO at <34 wk was similar to survival at >34 wk. • Gestational age of <34 wk may not be a contraindication to ECMO. [ABSTRACT FROM AUTHOR]

Congenital diaphragmatic hernia (CDH) is readily prenatally diagnosed and associated with significant perinatal morbidity and mortality. Delivery at facilities with adequate resources for neonatal resuscitation, such as Children's Surgery Verification (CSV) centers, is recommended; however, disparities have been clinically noted. We aimed to characterize locoregional care of CDH and the impact of race and ethnicity. We conducted a population-based study using the Texas Inpatient Public Use Data File to identify infants <1 y-old with CDH based on international classification of diseases 9/10 codes (2013-2021). Only initial birth admissions in the Houston region were included. Data was analyzed using descriptive statistics and chi-squared analysis. We identified 257 newborns with CDH. While births were noted across 29 facilities, the majority were at the 2 CSV centers in Houston. There was no significant difference in illness severity, prematurity or insurance status by race. Black and 'other' patients were less likely to deliver at CSV facilities (Black 32% versus 'Other' 48% versus White 70% versus Asian 81%; P < 0.01), receive ECMO (Black 6% versus 'Other' 5% versus White 19% versus Asian 29%; P < 0.01) or undergo a CDH repair (Black 26% versus 'Other' 33% versus White 51% versus Asian 71%; P < 0.01) on their index admission and had lower average daily costs (Black $10,292 [$3219-25,021] versus 'Other' $9106 [$3617-15,672] versus White $12,906 [$9038-18,550] versus Asian $12,896 [$7469-23,817]; P < 0.05). Additionally, black and 'other' patients were more likely to be transferred (Black 23% versus 'Other' 28% versus White 12% versus Asian 14%; P < 0.05). None of the patients born at CSV centers transferred. Most Houston-born patients deliver at high-resource centers; however, Black and 'other' patients are less likely to deliver at CSV centers and more likely to require transfer during the critical neonatal period. This suggests a vulnerable population which may benefit from targeted intervention to improve prenatal care and delivery planning. [ABSTRACT FROM AUTHOR]

A recent European randomized trial – Tracheal Occlusion To Accelerate Lung Growth – demonstrated that fetoscopic endoluminal tracheal occlusion (FETO) is associated with increased postnatal survival among infants with severe congenital diaphragmatic hernia (CDH). However, this differs in middle-income countries such as Brazil, where abortion is illegal and neonatal intensive care is inadequate. This study evaluated the effects of FETO on improving the survival of infants with moderate-to-severe CDH in isolated and non-isolated cases. This retrospective cohort study selected 49 fetuses with CDH, a normal karyotype, and a lung-to-head ratio (LHR) of <1 from a single national referral center for fetal surgery in São Paulo, Brazil, between January 2016 and November 2019. FETO was performed between 26 and 29 weeks of gestation. The primary outcomes were infant survival until discharge from the neonatal intensive care unit and survival until six months of age. Forty-six women with singleton fetuses having severe CDH underwent prenatal intervention with FETO. Infant survival rates until discharge and at six months of age were both 38 %. The observed-to-expected LHR increased by 25 % after FETO in neonates who survived until discharge. Spontaneous intrauterine death occurred in four growth-restricted fetuses after FETO. Preterm birth in <37 weeks and preterm rupture of membranes in <34 weeks occurred in 56.5 % (26) and 26 % (12) cases, respectively. FETO may increase neonatal survival in fetuses with severe CDH, particularly in countries with limited neonatal intensive care. [ABSTRACT FROM AUTHOR]

Objective: To assess and compare the value of antenatally determined observed‐to‐expected (O/E) lung‐area‐to‐head‐circumference ratio (LHR) on ultrasound examination vs O/E total fetal lung volume (TFLV) on magnetic resonance imaging (MRI) examination to predict postnatal survival of fetuses with isolated, expectantly managed left‐sided congenital diaphragmatic hernia (CDH). Methods: This was a multicenter retrospective study including all consecutive fetuses with isolated CDH that were managed expectantly in Mannheim, Germany, and in five other European centers, that underwent at least one ultrasound examination for measurement of O/E‐LHR and one MRI scan for measurement of O/E‐TFLV during pregnancy. All MRI data were centralized, and lung volumes were measured by two experienced operators blinded to the pre‐ and postnatal data. Multiple logistic regression analyses were performed to examine the effect on survival at hospital discharge of various perinatal variables, including the center of management. In left‐sided CDH with intrathoracic herniation of the liver, receiver‐operating‐characteristics (ROC) curves were constructed separately for cases from Mannheim and the other five European centers and were used to compare O/E‐TFLV and O/E‐LHR in the prediction of postnatal survival. Results: From Mannheim, 309 patients were included with a median gestational age (GA) at ultrasound examination of 29.6 (range, 19.7–39.1) weeks and median GA at MRI examination of 31.1 (range, 18.0–39.9) weeks. From the other five European centers, 116 patients were included with a median GA at ultrasound examination of 26.7 (range, 20.6–37.6) weeks and median GA at MRI examination of 27.7 (range, 21.3–37.9) weeks. Regression analysis demonstrated that the survival rates at discharge were lower in left‐sided CDH (odds ratio (OR), 0.349 (95% CI, 0.133–0.918), P = 0.033) and those with intrathoracic liver (OR, 0.297 (95% CI, 0.141–0.628), P = 0.001), and higher with increasing O/E‐TFLV (OR, 1.123 (95% CI, 1.079–1.170), P < 0.001), advanced GA at birth (OR, 1.294 (95% CI, 1.055–1.588), P = 0.013) and when birth occurred in Mannheim (OR, 7.560 (95% CI, 3.368–16.967), P < 0.001). Given the difference in survival rate between Mannheim and the five other European centers, ROC curve comparisons between the two imaging modalities were presented separately. For cases of left‐sided CDH with intrathoracic herniation of the liver, pairwise comparison showed no significant difference between the area under the ROC curves for the prediction of postnatal survival between O/E‐TFLV and O/E‐LHR in Mannheim (mean difference = 0.025, P = 0.610, standard error = 0.050), whereas there was a significant difference in the other European centers studied (mean difference = 0.056, P = 0.033, standard error = 0.056). Conclusions: In fetuses with left‐sided CDH and intrathoracic herniation of the liver, the predictive value for postnatal survival of O/E‐TFLV on MRI examination and O/E‐LHR on ultrasound examination was similar in one center (Mannheim), but O/E‐TFLV had better predictive value compared to O/E‐LHR in the five other European centers. Hence, in these five European centers, MRI should be included in the diagnostic process for left‐sided CDH. © 2024 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Nationwide abortion restrictions resulting from the Dobbs v Jackson Women's Health Organization (2022) decision have generated confusion and uncertainty among healthcare professionals, with concerns for liability impacting clinical decision-making and outcomes. The impact on pediatric surgery can be seen in prenatal counseling for fetal anomaly cases, counseling for fetal intervention, and recommendations for pregnant children and adolescents who seek termination. It is essential that all physicians and healthcare team members understand the legal implications on their clinical practices, engage with resources and organizations that can help navigate these circumstances, and consider advocating for patients and themselves. Pediatric surgeons must consider the impact of these changing laws on their ability to provide comprehensive and ethical care and counseling to all patients. [ABSTRACT FROM AUTHOR]

This prospective study describes the occurrence, morphology and localisation of type 1 abomasal ulcers (AU1) in various diseases of buffaloes and cattle. The carcasses were examined to confirm the cause of death. The abomasa were examined for AU1 and their characteristics. The AU1 were categorised into four subtypes, 1a, 1b, 1c and 1d, as per standard procedure. Traumatic reticuloperitonitis/pericarditis, reticular diaphragmatic hernia, intestinal obstruction, peritonitis, bronchopneumonia and theileriosis were the common causes for AU1. The overall prevalence of AU1 was 62.9%, which did not differ significantly with species and age. The prevalence of acute ulcers (1a and 1b) was significantly higher than that of chronic ulcers (1c and 1d). Most AU1 were located in the caudal third of abomasal body on parietal surface along the greater curvature. Most of the 1a ulcers were located in the pylorus, while 1b, 1c and 1d were located in the abomasal body. The overall prevalence of AU1 was lower (P<0.05) in the fundus than in other anatomical regions of the abomasum. Type 1b ulcers were more numerous than other subtypes. It was concluded that AU1 may be an important cause of slow recovery/poor prognosis under clinical situations and hence, the therapy protocol for such cases should include treatment for probable gastrointestinal bleeding. [ABSTRACT FROM AUTHOR]

Copyright of Medicina (Buenos Aires) is the property of Medicina (Buenos Aires) 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.)

Peritoneopericardial diaphragmatic hernia is a congenital structural anomaly that results in a communication between the pericardial sac and the peritoneal cavity. About 50% of cats are asymptomatic at the time of diagnosis, and the remaining animals may show respiratory (dyspnoea, tachypnoea, exercise intolerance), gastrointestinal, cardiac tamponade or non-specific clinical signs. Median celiotomy for herniorrhaphy without tension (primary closure, muscle flaps, synthetic mesh, pericardium) is the treatment of choice for symptomatic patients. Two cats were referred with respiratory signs, secondary to a peritoneopericardial diaphragmatic hernia. A pericardial patch graft was obtained and sutured to the diaphragm as an alternative technique to close the large defect and not cause excessive tension on the diaphragm and caval foramen. Patients recovered well without any complications after surgery. Re-examination and thoracic radiographs at 1 week, 2 weeks, 3 months, 6 months and 3 years postoperatively showed no signs of recurrence and the patients remained asymptomatic. [ABSTRACT FROM AUTHOR]

Congenital diaphragmatic hernia (CDH) is a developmental disorder in which the diaphragm, the muscle that separates the chest from the abdomen, does not close during prenatal development, allowing abdominal organs to herniate into the chest cavity. It occurs mainly on the left side (80%-85% of cases). CDH is often identified during prenatal assessment. However, instances of late-presenting CDH beyond infancy are exceedingly uncommon, contributing to frequent misdiagnosis and delayed therapeutic intervention. We present a case of a 10-month-old female with an uneventful antenatal and perinatal history who presented with respiratory distress and multiple episodes of vomiting. Her vital signs were stable upon arrival, but she was sent to the PICU due to hypoactivity, reduced oral intake, and agitation. After an urgent CT scan, a herniation of the small and large bowel loops into the right hemithorax was discovered, along with a defect in the right hemidiaphragm. This resulted in a pleural effusion on the right side, a partially collapsed left lung, and a mediastinal shift to the left. The diaphragmatic hernia was corrected through a lateral thoracotomy at the sixth rib with multiple interrupted sutures, and a chest tube was then inserted into the pleural space above the diaphragm following a smooth reduction of the bowl. This case highlights the importance of early diagnosis, appropriate clinical investigation, and treatment. A good prognosis can be anticipated by promptly discovering and examining the condition.

Diaphragmatic hernias are a rare finding in adult population, especially in urgent settings. Nevertheless, the acute symptoms can be life-threatening and may require urgent surgical intervention. We report a rare case of a nontraumatic diaphragmatic hernia in a young adult with a history of laparotomy at the age of 1, suggesting a pre-existing malformation. The clinical presentation was dominated by respiratory symptoms and biological signs of hepatic ischemia, with no abdominal pain. Computed tomography demonstrated protrusion of the entire liver into the thoracic cavity. In this context, an emergency laparotomy was performed. The liver was reintroduced to the abdominal cavity, and the diaphragmatic defect repaired using a synthetic mesh, resulting in resolution of symptoms and a smooth postoperative recovery. Our case highlights the need for efficient diagnosis of the diaphragmatic hernias in adults, even without the context of trauma. A prompt and adequate repair of the defect, usually interposing a synthetic mesh, allows for complete and relatively fast recovery.

Background: Small bowel obstruction (SBO) is a known complication following congenital diaphragmatic hernia (CDH) repair, resulting in significant morbidity and potential mortality. Our study aims to evaluate the incidence and risk factors for SBO following CDH repair. Methods: A single-institution retrospective review evaluated all CDH births between January 2010 and September 2022 (n = 120). Risk factors for SBO were analyzed, including operative approach, type of repair, need for extracorporeal membrane oxygenation (ECMO), and additional abdominal surgeries (gastrostomy tube and fundoplication). Results: 120 patients were included. 16 (13%) patients developed an SBO, of which 94% were due to adhesive bands. The median time to SBO was 7.5 months. 15/16 (94%) patients required operative intervention. Need for ECMO (P < 0.01), prior gastrostomy tube (P < 0.01), and prior fundoplication (P < 0.01) were associated with an increased risk of SBO, as were longer time to initial CDH repair (6 days vs 3 days; P < 0.01) and longer length of initial hospitalization (63 days vs 29 days; P = 0.01). Discussion: Neonates with increased acuity of illness (ie, those requiring ECMO, additional abdominal operations, longer time to repair, and longer initial hospitalizations) appear to have an increased risk of developing adhesive SBO after CDH repair. More than 90% of patients who developed SBO required surgery. [ABSTRACT FROM AUTHOR]

Hiatal hernia, para-hiatal hernia, diaphragmatic hernia, diaphragmatic agenesis and diaphragmatic eventration are the main types of the diseases with diaphragmatic anatomic abnormalities. Benign and malignant tumors of the diaphragm are not discussed in this paper. Caused by the lack of knowledge about these diseases, improper imaging, clinical diagnosis is often confusing. Based on the literatures and our own experience, this paper proposes the concept of “diseases with diaphragmatic anatomic abnormalities”. The purpose is to summarize these diseases, and briefly describe the treatment methods, and to help strengthen the understanding and treatment of such diseases.

Summary: A retrospective review of 44 cases of congenital diaphragmatic hernia (CDH) treated at the Cardiothoracic Surgical Unit, University College Hospital (UCH), Ibadan, between August 1976 and May 1999, was carried out. Thirty (68.2 per cent) of the 44 were males and 14 (13.8 per cent) were females. The patients were analysed in three groups: 31 patients who underwent surgery were analysed as two groups: inborn (born within UCH), 10 patients, and outborn (born elsewhere), 21 patients; the third group consisted of 13 patients who were not operated upon. All the inborn patients and 18 (85.7 per cent) of the outborn had left-sided defects; the remaining three of the outborn had right-sided defects. Eleven (84.6 per cent) of those who didn't undergo surgery, had left-sided defects while the remaining 15.4 per cent had bilateral defects. The three groups had comparable gestational ages (inborn vs outborn, p> 0.05; inbom vs unoperated, p> 0.05; outborn vs unoperated, p>0.05) and birth weights (inborn vs outborn, p>0.05; inborn vs unoperated, p>0.05; outborn vs unoperated, p>0.05). Those who did not undergo surgery had lower Apgar scores and higher incidence of associated congenital malformations than the patients who underwent surgical repairs. The differences in the mean of 5 minute Apgar scores among the three groups were not statistically significant (p>0.05). Age at surgery was higher in the outborn (mean 55.5 42.2 hours) than the inborn (mean 9.2 + 3.9 hours) patients. The difference between the mean age at surgery was statistically significant (p< 0.05). Majority of those requiring operation (24 patients, 77.4 per cent) had repair by thoracotomy, while the remaining seven (22.6 per cent) had repair by the abdominal approach. Most of the patients had primary repair while two required diaphragmatic patches with dacron. Sixty per cent of the inborn patients required post operative ventilation compared with only 23.8 per cent of the outborn. Survival was 71.4 per cent for the outborn and 40 per cent for the inborn. It is concluded that CDH is a disease with a range of severity. The higher survival rate among the more mature outborns suggest a natural selection of those with minimum respiratory impairment.

Introduction: Patients who had suffered disease of atrial septal defect (ASD) coming by pulmonary hypertension (PH) often present a clinical dilemma. Both of these disorders are congenital anomalies that often appear in pediatrics. Anaesthetic management in diaphragmatic hernia repair with this comorbidity requires precision and accuracy to avoid morbidity and mortality during surgery. The right management and care of anesthetic procedures is needed for patients who will be operated on with these two disorders. Objective: To describe the anesthetic management of a diaphragmatic hernia repair patient with comorbid ASD and pulmonary hypertension. Case report: The patient, a 1.5-month-old female baby born, has presented with shortness of breath complaints since the birth. Those were born spontaneously at the midwife's office and did not cry immediately, and a history of blueing and decreased consciousness was admitted for 20 days. Based on the examination, the diagnosis of diaphragmatic hernia from echocardiography found ASD and PH with a left ventricular ejection fraction of 64%. The patient was planned for diaphragmatic hernia repair under general anesthesia. Induction of anesthesia was performed with 5 mcg of fentanyl and inhalation anesthetic 3.5 vol% sevoflurane. After the endotracheal tube (ETT) was attached, the patient was desaturated to 50%, then the hyperventilated oxygenation was performed and positioned with knee chest position, and then milrinone at a dose of 1 mcg/min was given, saturation rose to 100%. During intraoperative ventilation control with manual bagging and maintenance anesthesia with inhalation ansethetic sevoflurane of 3.2 vol%. After surgery, the patient was admitted and observed in the pediatric intensive care unit for 2 days before extubation. Conclusion: Appropriate perioperative management in ASD patients with PH can reduce perioperative morbidity and mortality.

Background: Post-traumatic diaphragmatic hernia (PTDH) is a rare condition that can transition from acute to chronic states, often eluding immediate diagnosis due to obscured symptoms in the emergency setting. The delayed manifestation of PTDH can lead to severe complications such as intestinal obstruction and respiratory distress associated with high rates of morbidity and mortality. Case description: We report a case involving a 74-year-old female patient with delayed onset of symptoms of chronic PTDH (CPTDH) with a history of traffic accident three years before presentation, successfully treated with a minimally invasive laparoscopic approach. Conclusion: Early recognition and adequate management of CPTDH are crucial for minimizing morbidity and mortality. Minimally invasive techniques provide notable benefits in patient care, underscoring the ongoing advancement in surgical approaches.

Diaphragmatic hernia in children is uncommon, especially when not congenital. We present a case of an 11-year old boy with a diaphragmatic hernia caused by a rib osteochondroma. The osteochondroma was surgically removed and the laceration in the diaphragm was repaired. This case shows the importance of being familiar with acquired diaphragmatic hernia in children, to recognize and prevent possible complications in an early stage.

Purpose: Previous studies have shown a higher recurrence rate and longer operative times for thoracoscopic repair (TR) of congenital diaphragmatic hernia (CDH) compared to open repair (OR). An updated meta-analysis was conducted to re-evaluate the surgical outcomes of TR. Methods: A comprehensive literature search comparing TR and OR in neonates was performed in accordance with the PRISMA statement (PROSPERO: CRD42020166588). Results: Fourteen studies were selected for quantitative analysis, including a total of 709 patients (TR: 308 cases, OR: 401 cases). The recurrence rate was higher [Odds ratio: 4.03, 95% CI (2.21, 7.36), p < 0.001] and operative times (minutes) were longer [Mean Difference (MD): 43.96, 95% CI (24.70, 63.22), p < 0.001] for TR compared to OR. A significant reduction in the occurrence of postoperative bowel obstruction was observed in TR (5.0%) compared to OR (14.8%) [Odds ratio: 0.42, 95% CI (0.20, 0.89), p = 0.02]. Conclusions: TR remains associated with higher recurrence rates and longer operative times. However, the reduced risk of postoperative bowel obstruction suggests potential long-term benefits. This study emphasizes the importance of meticulous patient selection for TR to mitigate detrimental effects on patients with severe disease. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to clarify surgical complications associated with open surgery for congenital diaphragmatic hernia (CDH). Methods: We performed an exploratory data analysis of the clinical characteristics of surgical complications of neonates with CDH who underwent laparotomy or thoracotomy between 2006 and 2021. Data of these patients were obtained from the database of the Japanese CDH Study Group. Results: Among 1,111 neonates with left or right CDH, 852 underwent open surgery (laparotomy or thoracotomy). Of these 852 neonates, 51 had the following surgical complications: organ injury (n = 48; 6% of open surgeries); circulatory failure caused by changes in the organ location (n = 2); and skin burns (n = 1). Injured organs included the spleen (n = 30; 62% of organ injuries), liver (n = 7), lungs (n = 4), intestine (n = 4), adrenal gland (n = 2), and thoracic wall (n = 2). Fourteen of the patients who experienced organ injury required a blood transfusion (2% of open surgeries). The adjusted odds ratio of splenic injury for patients with non-direct closure of the diaphragm was 2.2 (95% confidence interval, 1.1–4.9). Conclusion: Of the patients who underwent open surgery for CDH, 2% experienced organ injury that required a blood transfusion. Non-direct closure of the diaphragmatic defect was a risk factor for splenic injury. [ABSTRACT FROM AUTHOR]