Imaging palpable tumors in pediatrics: Part 2.

Palpable tumors in children are a common reason for consulting a radiologist. The origin of these lesions varies widely, and although they are common, classic radiology books do not cover some of them. This series of two articles aims to review the clinical and radiological characteristics of a selection of palpable tumors in children that radiologists need to be familiar with.

LARVICIDE ACTIVITY OF LACTOBACILLUS SPP. AND SACCHAROMYCES BOULARDII SUPERNATANTS ON TOXOCARA CANIS.

Experimental studies have demonstrated the potential of probiotics to control visceral toxocariasis, which is a tissue parasitosis that is difficult to treat. This study evaluated the in vitro activity of probiotics and their supernatants on Toxocara canis larvae. The probiotics Lactobacillus rhamnosus (ATCC 7469), Lactobacillus paracasei (ATCC 335), Saccharomyces boulardii, Saccharomyces cerevisiae, and Bacillus cereus var. toyoi were tested in the following preparations: probiotic (P) 1 × 102 to 1 × 109 colony-forming units (CFUs), inactivated probiotic (IP) 1 × 102 to 1 × 109 CFUs, supernatant probiotic (SUpP), and inactivated probiotic supernatant (SupIP). The probiotics and their respective supernatants were separately incubated with 100 T. canis larvae per well using microculture plates with RPMI-1640 medium for 48 hr at 37 C and 5% CO2. The evaluation of the in vitro tests was based on the viability of T. canis larvae, through morphologic integrity, positive motility, and the absence of trypan blue stain. Only culture supernatants (SUpP and SUpIP) of Lactobacillus spp. resulted in 100% dead larvae, whereas S. boulardii showed larvicidal activity in T. canis >70%. The rest of the tests did not show larvicide activity. Therefore, it is important to investigate the supernatant effects of Lactobacillus spp. and S. boulardii in vivo on T. canis visceral infections, their mechanisms of action, and major metabolites involved.

Radiología de las tumoraciones palpables en el paciente pediátrico. Parte 2 / Imaging palpable tumors in pediatrics: Part 2

Las tumoraciones palpables en los niños son un motivo de consulta muy habitual para el radiólogo. El origen de las lesiones es muy variado, y algunas de ellas no reciben atención en los libros clásicos de Radiología, pese a encontrarse frecuentemente.El objetivo de esta serie de 2 artículos es revisar las características clínico-radiológicas de una selección de estas entidades que consideramos importante conocer. (AU)

Palpable tumors in children are a common reason for consulting a radiologist. The origin of these lesions varies widely, and although they are common, classic radiology books do not cover some of them.This series of two articles aims to review the clinical and radiological characteristics of a selection of palpable tumors in children that radiologists need to be familiar with. (AU)

Imaging palpable tumors in pediatrics.

Palpable tumors in children are a common reason for consulting a radiologist. The differential diagnosis is extensive and considerably different from that used in adults. Some of the etiologies of palpable tumors are little known outside of pediatrics. The most commonly used imaging test is ultrasonography, because in addition to being harmless and cost-effective, it is conclusive in most cases. Most palpable lesions in children are benign; it is estimated that only 1% are malignant. Knowing these lesions enables the correct diagnosis without the need to resort to unnecessary, sometimes invasive tests, thus avoiding delays in treatment when more severe disease is present. This article aims to review the clinical and radiological characteristics of the palpable lesions that are most common in pediatric patients, explaining the key features that enable accurate diagnosis.

Radiología en las tumoraciones palpables del paciente pediátrico Parte 1 / Imaging palpable tumors in pediatrics

La presencia de una tumoración palpable en un niño es un motivo de consulta frecuente en Radiología. El diagnóstico diferencial es extenso y considerablemente diferente al del adulto. Algunas de las etiologías son poco conocidas fuera del ámbito pediátrico. La prueba de imagen más utilizada es la ecografía, porque además de inocua y coste-efectiva, es concluyente en la mayoría de los casos. La mayor parte de las lesiones son de naturaleza benigna. Se estima que solo el 1% terminan en un diagnóstico de neoplasia maligna. Conocerlas permite hacer un diagnóstico correcto, sin tener que recurrir a pruebas innecesarias y a veces invasivas, así como evitar retrasos en el proceso asistencial cuando nos encontremos ante una enfermedad de mayor gravedad. El objetivo de este artículo es repasar las características clínico-radiológicas de las tumoraciones palpables más frecuentes en el paciente pediátrico, explicando los datos clave que permitan hacer un diagnóstico preciso.(AU)

Palpable tumors in children are a common reason for consulting a radiologist. The differential diagnosis is extensive and considerably different from that used in adults. Some of the etiologies of palpable tumors are little known outside of pediatrics. The most commonly used imaging test is ultrasonography, because in addition to being harmless and cost-effective, it is conclusive in most cases. Most palpable lesions in children are benign; it is estimated that only 1% are malignant. Knowing these lesions enables the correct diagnosis without the need to resort to unnecessary, sometimes invasive tests, thus avoiding delays in treatment when more severe disease is present. This article aims to review the clinical and radiological characteristics of the palpable lesions that are most common in pediatric patients, explaining the key features that enable accurate diagnosis.(AU)

Cyclosporine A increases the intensity of Toxocara canis infection in swiss mice.

Toxocariasis is a zoonotic disease of worldwide distribution. The connection between parasitic diseases and conditions that depress the immune system, such as the use of immunosuppressive drugs, has been studied. The purpose of this study was to evaluate the effect of Cyclosporine A (CsA) on the intensity of infection, humoral response and gene transcription of interleukins IL-4, IL-10 and IL-12 in mice experimentally infected with Toxocara canis. To this end, mice were divided into two groups treated with CsA (G1: 10 mg/Kg and G2: 50 mg/kg), the G3 and G4 group received PBS. After the last administration of the drug or PBS (orally every 48 hours for 15 days), groups G1, G2 and G3 were inoculated with 1200 eggs of T. canis. Was collected blood samples on days zero, 15 and 30 days post-inoculation (PI), for ELISA test and the mice were euthanized 30 days PI. The organs and striated muscle tissue were collected for the recovery of larvae. The splenocytes were analyzed by RT-PCR. The intensity of infection in the mice treated with 50 mg/kg of CsA was 65.5% higher than in the control group (p=0.001). An analysis of the kinetics of anti-Toxocara antibody revealed that the groups treated with CsA showed significantly higher mean levels of antibodies on day 15 PI. The transcription of the three tested interleukins showed no statistical difference between G2 and G3 (control). It was concluded that the immunosuppression triggered by CsA (50 mg/Kg) favored the establishment of a larger number of T. canis larvae without, however, altering immunoglobulin production and IL-4, IL-10 and IL-12 transcription on day 30 PI.

Tactile Stimulation in Adult Rats Modulates Dopaminergic Molecular Parameters in the Nucleus accumbens Preventing Amphetamine Relapse.

Amphetamine (AMPH) is a psychostimulant drug frequently related to addiction, which is characterized by functional and molecular changes in the brain reward system, favoring relapse development, and pharmacotherapies have shown low effectiveness. Considering the beneficial influences of tactile stimulation (TS) in different diseases that affect the central nervous system (CNS), here we evaluated if TS applied in adult rats could prevent or minimize the AMPH-relapse behavior also accessing molecular neuroadaptations in the nucleus accumbens (NAc). Following AMPH conditioning in the conditioned place preference (CPP) paradigm, male rats were submitted to TS (15-min session, 3 times a day, for 8 days) during the drug abstinence period, which were re-exposed to the drug in the CPP paradigm for additional 3 days for relapse observation and molecular assessment. Our findings showed that besides AMPH relapse, TS prevented the dopamine transporter (DAT), dopamine 1 receptor (D1R), tyrosine hydroxylase (TH), mu opioid receptor (MOR) increase, and AMPH-induced delta FosB (ΔFosB). Based on these outcomes, we propose TS as a useful tool to treat psychostimulant addiction, which is subsequent to clinical studies; it could be included in detoxification programs together with pharmacotherapies and psychological treatments already conventionally established.

Saccharomyces boulardii reduces the vertical transmission of Toxocara canis larvae in mice.

Probiotics have been shown to reduce the intensity of Toxocara canis infection in mice. However, larval transmission of this nematode also occurs via transplacental and transmammary routes. Thus, the aim of this study was to evaluate the effect of the Saccharomyces boulardii probiotic on the vertical transmission of T. canis in Swiss mice. The mice received 107S. boulardii colony-forming units per gram of food. The supplementation began 15 days before mating and was maintained throughout pregnancy and lactation. The animals were inoculated with 300 T. canis embryonated eggs on the 14th day of pregnancy. The presence of larvae was examined in the organs of the females and their offspring. The examined organs included the following: brain, liver, lungs, heart, kidneys, spleen, eye, skeletal muscle (carcass) and mammary glands of lactating females. There was a 42% (P = 0.041) reduction in the number of larvae transmitted to offspring in the group that received probiotic-supplemented food (GI). Additionally, there was a 50% reduction (P = 0.023) in the number of larvae found in the brains of lactating offspring in the GI group. These results reveal the potential of S. boulardii probiotic use as an auxiliary method of controlling visceral toxocariasis.

Toxocara canis infection may impair bovine herpesvirus type 5 immunization.

Helminths have developed complex mechanisms to suppress the host immune response. These mechanisms may impair the host vaccine response. This study aimed to evaluate the effect of Toxocara spp. infection on the vaccine immune response to bovine herpesvirus type 5 (BoHV-5). First, 30 heifers received two doses of an experimental BoHV-5 vaccine. At 42nd days after the primo vaccination the vaccine efficacy was evaluated, and the presence of anti-Toxocara antibodies. Second, 20 Balb/c mice were divided into two groups, one infected with T. canis and the other without infection. After infection, both groups received two doses of vaccine. The vaccine immune response was assessed by BoHV-5 serum neutralization and splenic cytokines transcription by qPCR. All heifers positive for Toxocara spp. (40%) showed BoHV-5 SN titer ≤1:32, whereas heifers negative for Toxocara spp. (60%) had BoHV-5 SN titer ≥1: 128. Infected T. canis mice showed BoHV-5 SN titer ≤1:2, whereas mice not infected with T. canis BoHV-5 SN titer ≥1:8. Splenocytes from control mice stimulated with BoHV-5 had a significant (p < .05) mRNA transcription for the cytokines IL-12, IL-17, and IL-23, whereas the same cytokines were down-regulated in T. canis infected mice. These results suggest that Toxocara spp. infection may impair BoHV-5 immunization and should be considered for efficient herd immunization.

Frequency of enteroparasitic infections and serum positivity for Toxocara spp. in children from a public day care center in Southern Brazil / Frequência de enteroparasitos e de soropositividade para Toxocara spp. em crianças de uma creche pública do Sul do Brasil

Abstract Introduction Day care centers play an important social role in children's early education and development. The objective of this study was to investigate the frequency of intestinal parasitic infections and infection with Toxocara spp. in children from a day care center in the city of Rio Grande, Rio Grande do Sul, Brazil. Methods: The study was conducted using fecal samples from 50 children, ages three to six years, using Ritchie, Faust, Rugai, and Kinyoun's techniques. A closed and structured epidemiological questionnaire was used to collect data from the parents/guardians of the children. Serological studies for detection of antibodies to Toxocara spp. by immunoenzymatic assays using Toxocara excretion and secretion antigen (TES) were conducted on sera collected from 41 children. Results: The frequency of enteroparasites was 18%, with 43.9% of the children testing seropositive for Toxocara spp. Low family income and low literacy levels of parents/guardians were common factors between the families of the parasite-positive children. For the children who tested positive for Toxocara spp., most of the parents/guardians reported using only water for sanitizing raw vegetables and fruits. Conclusions: The high seropositivity rates for Toxocara spp. indicate that children were exposed to this parasite, and it is important to reduce the risk of infection. In addition, the seropositivity for enteroparasites and the interviews with the parents/guardians indicate the need to educate the studied population regarding the modes of intestinal parasite transmission and the prophylactic measures needed to prevent their dissemination.

Resumo Introdução As creches desempenham um importante papel social na educação e desenvolvimento inicial das crianças. O objetivo deste estudo foi investigar a frequência de infecções parasitárias intestinais, além de infecção por Toxocara spp. em crianças de uma creche na cidade do Rio Grande, Rio Grande do Sul, Brasil. Métodos: Para o estudo, foram coletadas amostras fecais de 50 crianças de três a seis anos, analisadas pelas técnicas de Ritchie, Faust, Rugai e Kinyoun, sendo aplicado um questionário epidemiológico fechado e estruturado aos pais/responsáveis ​​das crianças. Também foi realizada uma pesquisa sorológica de anticorpos para Toxocara spp. em 41 crianças, pelo ensaio imunoenzimático, associado ao antígeno de excreção e secreção (ES), com soros pré-adsorvidos com antígeno somático de Ascaris lumbricoides. Resultados: A frequência de enteroparasitos foi de 18%, enquanto que 43.9% das crianças foram soropositivas para Toxocara spp.. Baixa renda familiar e baixo nível de alfabetização dos pais/responsáveis ​​foram fatores comuns entre as famílias das crianças parasitadas. A maioria dos pais ou responsáveis das crianças, com diagnóstico positivo para enteroparasitos ou para Toxocara spp., relatou utilizar apenas água para a higienização de verduras e frutas. Conclusões: As altas taxas de soropositividade para Toxocara spp. indicam que as crianças foram expostas a esse parasito, sendo importante minimizar o risco de infecção. Além disso, a positividade de 18% para enteroparasitos e os dados obtidos com as entrevistas realizadas com os pais ou responsáveis demonstram a necessidade da realização de trabalhos com a população estudada que visem a divulgação sobre as parasitoses intestinais, especialmente sobre medidas profiláticas especificas.

Frequency of enteroparasitic infections and serum positivity for Toxocara spp. in children from a public day care center in Southern Brazil.

INTRODUCTION: Day care centers play an important social role in children's early education and development. The objective of this study was to investigate the frequency of intestinal parasitic infections and infection with Toxocara spp. in children from a day care center in the city of Rio Grande, Rio Grande do Sul, Brazil. Methods: The study was conducted using fecal samples from 50 children, ages three to six years, using Ritchie, Faust, Rugai, and Kinyoun's techniques. A closed and structured epidemiological questionnaire was used to collect data from the parents/guardians of the children. Serological studies for detection of antibodies to Toxocara spp. by immunoenzymatic assays using Toxocara excretion and secretion antigen (TES) were conducted on sera collected from 41 children. Results: The frequency of enteroparasites was 18%, with 43.9% of the children testing seropositive for Toxocara spp. Low family income and low literacy levels of parents/guardians were common factors between the families of the parasite-positive children. For the children who tested positive for Toxocara spp., most of the parents/guardians reported using only water for sanitizing raw vegetables and fruits. Conclusions: The high seropositivity rates for Toxocara spp. indicate that children were exposed to this parasite, and it is important to reduce the risk of infection. In addition, the seropositivity for enteroparasites and the interviews with the parents/guardians indicate the need to educate the studied population regarding the modes of intestinal parasite transmission and the prophylactic measures needed to prevent their dissemination.

Saccharomyces boulardii modulates and improves the immune response to Bovine Herpesvirus type 5 Vaccine / Saccharomyces boulardii modula e melhora a resposta imune de vacina contra o Herpes bovino tipo 5

There have been significant efforts towards the development of more efficient vaccines for animal health. A strategy that may be used to improve vaccine efficacy is the use of probiotics to enhance the immune response of the host, leading to increased immunogenicity of antigen preparations. Bovine herpesvirus 5 (BoHV-5) is an example of an important animal pathogen for which vaccines have provided only limited protection. In this study, we examined the use of the probiotic Saccharomyces boulardii (Sb) as a potential adjuvant to improve vaccine efficiency. We found that the supplemented animals exhibited an enhanced systemic IgG antibody response toward a Th1 response in favor of IgG2a and increased mRNA expression levels of the cytokines IFN-y, IL-12, IL-17 and IL-10 in the spleen. These results suggest that Sb supplementation may provide a promising means for improving the efficiency of vaccines, particularly those that rely on a cell-mediated immune response.(AU)

Esforços significativos têm sido realizados para o desenvolvimento de vacinas mais eficientes em saúde animal. Uma estratégia que pode ser usado para melhorar a eficácia da vacina é o uso de probióticos para melhorar a resposta imune do hospedeiro, conduzindo ao aumento da imunogenicidade de preparações de antígenos. Herpesvírus bovino 5 (BoHV-5) é um exemplo de um importante patógeno animal para os quais vacinas têm fornecido apenas uma protecção limitada. Neste estudo, examinou-se o uso do probiótico Saccharomyces boulardii (Sb) como um adjuvante potencial para melhorar a eficiência da vacina. Verificou-se que os animais suplementados apresentaram uma produção de anticorpos IgG superior e com desvio para Th1 em favor de IgG2, além do aumento dos níveis de expressão de mRNA para as citocinas IFN-γ, IL-12, IL-17 e IL-10. Esses resultados sugerem que a suplementação de Sb pode fornecer um meio promissor para melhorar a eficiência de vacinas, particularmente aquelas que dependem de uma resposta imune mediada por células.(AU)

A computational framework to characterize and compare the geometry of coronary networks.

This work presents a computational framework to perform a systematic and comprehensive assessment of the morphometry of coronary arteries from in vivo medical images. The methodology embraces image segmentation, arterial vessel representation, characterization and comparison, data storage, and finally analysis. Validation is performed using a sample of 48 patients. Data mining of morphometric information of several coronary arteries is presented. Results agree to medical reports in terms of basic geometric and anatomical variables. Concerning geometric descriptors, inter-artery and intra-artery correlations are studied. Data reported here can be useful for the construction and setup of blood flow models of the coronary circulation. Finally, as an application example, similarity criterion to assess vasculature likelihood based on geometric features is presented and used to test geometric similarity among sibling patients. Results indicate that likelihood, measured through geometric descriptors, is stronger between siblings compared with non-relative patients. Copyright © 2016 John Wiley & Sons, Ltd.

Frequency of enteroparasitic infections and serum positivity for Toxocara spp. in children from a public day care center in Southern Brazil

Abstract Introduction Day care centers play an important social role in childrens early education and development. The objective of this study was to investigate the frequency of intestinal parasitic infections and infection with Toxocara spp. in children from a day care center in the city of Rio Grande, Rio Grande do Sul, Brazil. Methods: The study was conducted using fecal samples from 50 children, ages three to six years, using Ritchie, Faust, Rugai, and Kinyouns techniques. A closed and structured epidemiological questionnaire was used to collect data from the parents/guardians of the children. Serological studies for detection of antibodies to Toxocara spp. by immunoenzymatic assays using Toxocara excretion and secretion antigen (TES) were conducted on sera collected from 41 children. Results: The frequency of enteroparasites was 18%, with 43.9% of the children testing seropositive for Toxocara spp. Low family income and low literacy levels of parents/guardians were common factors between the families of the parasite-positive children. For the children who tested positive for Toxocara spp., most of the parents/guardians reported using only water for sanitizing raw vegetables and fruits. Conclusions: The high seropositivity rates for Toxocara spp. indicate that children were exposed to this parasite, and it is important to reduce the risk of infection. In addition, the seropositivity for enteroparasites and the interviews with the parents/guardians indicate the need to educate the studied population regarding the modes of intestinal parasite transmission and the prophylactic measures needed to prevent their dissemination.

Resumo Introdução As creches desempenham um importante papel social na educação e desenvolvimento inicial das crianças. O objetivo deste estudo foi investigar a frequência de infecções parasitárias intestinais, além de infecção por Toxocara spp. em crianças de uma creche na cidade do Rio Grande, Rio Grande do Sul, Brasil. Métodos: Para o estudo, foram coletadas amostras fecais de 50 crianças de três a seis anos, analisadas pelas técnicas de Ritchie, Faust, Rugai e Kinyoun, sendo aplicado um questionário epidemiológico fechado e estruturado aos pais/responsáveis das crianças. Também foi realizada uma pesquisa sorológica de anticorpos para Toxocara spp. em 41 crianças, pelo ensaio imunoenzimático, associado ao antígeno de excreção e secreção (ES), com soros pré-adsorvidos com antígeno somático de Ascaris lumbricoides. Resultados: A frequência de enteroparasitos foi de 18%, enquanto que 43.9% das crianças foram soropositivas para Toxocara spp.. Baixa renda familiar e baixo nível de alfabetização dos pais/responsáveis foram fatores comuns entre as famílias das crianças parasitadas. A maioria dos pais ou responsáveis das crianças, com diagnóstico positivo para enteroparasitos ou para Toxocara spp., relatou utilizar apenas água para a higienização de verduras e frutas. Conclusões: As altas taxas de soropositividade para Toxocara spp. indicam que as crianças foram expostas a esse parasito, sendo importante minimizar o risco de infecção. Além disso, a positividade de 18% para enteroparasitos e os dados obtidos com as entrevistas realizadas com os pais ou responsáveis demonstram a necessidade da realização de trabalhos com a população estudada que visem a divulgação sobre as parasitoses intestinais, especialmente sobre medidas profiláticas especificas.

Modulation of IL-12 and IFNγ by probiotic supplementation promotes protection against Toxocara canis infection in mice.

In this study, supplementation with the probiotic Saccharomyces boulardii promoted a reduction in intensity of infection by Toxocara canis and modulates cytokines mRNA expression in experimentally infected mice. IL-12 gene transcription had 40-fold increase in S. boulardii supplemented uninfected mice and sevenfold increase in supplemented infected mice comparing with not supplemented group. Regarding IFNγ, similar results were observed, since probiotic supplementation induced approximately 43-fold increase, but only in uninfected mice (P < 0·05). T. canis infection upregulated IL-10 expression while S. boulardii downregulated it and no change was observed for IL-4. Thus, based in these findings; we suggest that one possible mechanism responsible for S. boulardii protection effect against T. canis infection is by the modulation of cytokines expression, especially IL-12.

[Prenatal techniques to prevent central nervous system malformations in the surgically induced model of myelomeningocele]. / El modelo de mielomeningocele en oveja presenta alteraciones cerebrales semejantes a las del humano y estas pueden ser prevenidas mediante cirugía fetal abierta.

AIM: To describe central nervous system malformations in the surgically induced model of Myelomeningocele (MMC) and their prevention using different prenatal treatments. METHODS: MMC was surgically created in 33 fetal lambs. Fifteen did not undergo fetal repair (group A). Of the lambs that did undergo repair, 10 were repaired with open two layer surgical closure (group B), 5 with fetoscopic coverage using bioglue (group C) and 3 fetoscopically using a patch (group D). All procedures were recorded and lamb brains and spinal cords were examined grossly and microscopically in coronal sections for structural organization anomalies. Histopathological changes were assessed using HE and S-100 neural marker. RESULTS: Hydrocephalus, Arnold-Chiari type II (AC-II) malformation and some neuronal migration disorders were observed in group A. Brains from group B and D were not hydrocephalic and had neither cell migration disorders nor hindbrain herniation. Group C presents mild degrees of hydrocephalus and AC-II. In group C lumbar lesion was covered by fibrous tissue. CONCLUSIONS: Some of the central nervous system abnormalities observed in human disease are present in the surgically induced model of MMC. In this model avoidance of fluid drainage using open fetal surgery limits malformation severity.

Holographic technique for measurement of the kinetic constant and optical modulation of photosensitive materials.

We use a holographic technique to measure simultaneously and separately the temporal evolution of the refractive-index and the absorption coefficient modulations induced by light in a photosensitive material. The technique is phase sensitive, allowing separation of the signals from the phase and from the amplitude grating. The refractive-index and the absorption coefficient modulations as well as the kinetic constant of the photoreaction in the positive photoresist SC 1827 were measured at three different wavelengths. The results were compared with independent measurements, performed under homogeneous exposition. The good accord demonstrates the applicability of the technique to study photosensitive materials.

[Bladder malformations in a model of myelomeningocele. Preliminary report]. / Influencia del tipo de cobertura prenatal sobre el desarrollo vesical en un modelo de mielomeningocele.

PURPOSE: To describe the presence of bladder malformations in a surgically induced model of myelomeningocele (MMC). METHODS: A MMC like defect was created in the mid gestation using the previously described model in sheep. Bladders were examined macroscopically and histopathological changes were assessed using H-E. RESULTS: Non prenatally corrected animals presented dilated bladders and separation between muscle bundles. Those malformations were not found in corrected animals or controls. CONCLUSIONS: Some bladder changes can be described in a surgically-induced model of MMC. These changes could be prevented using open fetal surgery.

[Morbility and mortality associated with prosthetic patch in congenital diaphragmatic hernia]. / Morbimortalidad en pacientes con parche protésico para el cierre de la hernia diafragmática congénita.

AIM: To analyze morbility, mortality and neonatal intensive care management in CDH patients who required a prosthetic patch to close the diaphragmatic defects, and to compare these results with those who were made a primary closure. MATERIAL AND METHODS: We reviewed the clinical charts of CDH patients managed at our institution between January 1994 and December 2006, including demographic data, clinical management, treatment options, complications and mortality. Appropriate statistical tests were used to evaluate the data: mortality, need of high frequency oscillatory ventilation (HFOV), days of intubation, days of total parenteral nutrition (TPN), days of admission, reherniation, need of Nissen funduplication and intestinal obstruction; a p value less than 0.05 was considered statistically significant. RESULTS: Eighty-seven CDH patients were reviewed, 68 right, 17 left and 2 bilateral defects. Seventeen died before surgery (19.5%). Among the 70 operated patients, 21 (24.1%) required a prosthetic patch, 18 in the left and 3 in the right side. Overall mortality, need of HFOV, intubation days, need of TPN, days of admission, reherniation rate and need of Nissen funduplication were all significantly worse in the group who required a patch. Rate of intestinal obstruction was similar in both groups. CONCLUSIONS: Patients who required a prosthetic patch to close the diaphragmatic defect suffered from higher morbidity and presented a higher mortality than those who did not required the patch.