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1.
Asian J Endosc Surg ; 12(3): 318-321, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30411524

RESUMO

Diaphragmatic eventration refers to an abnormal elevation of the diaphragm. Here, we report the case of a patient with gastric cancer who underwent successful laparoscopic distal gastrectomy despite the presence of diaphragmatic eventration. The patient was a 72-year-old man diagnosed with early gastric cancer in the antrum, as detected by upper gastrointestinal endoscopy. Preoperative imaging revealed an elevation of the left side of the diaphragm, which was diagnosed as diaphragmatic eventration. Laparoscopic surgery is beneficial for obtaining an optimal field of view. However, there are critical points that must be considered when laparoscopic distal gastrectomy is performed in patients with gastric cancer complicated by diaphragmatic eventration. There were difficulties that affected manipulation because the elevated diaphragm drew the intraperitoneal organs into the thoracic cavity, causing displacement of the normal anatomical position. We found it beneficial to secure the lesser curvature of the stomach given the possible effects of gastric deformation.


Assuntos
Adenocarcinoma/cirurgia , Eventração Diafragmática/complicações , Gastrectomia , Laparoscopia , Neoplasias Gástricas/complicações , Neoplasias Gástricas/cirurgia , Adenocarcinoma/complicações , Adenocarcinoma/patologia , Idoso , Humanos , Masculino , Neoplasias Gástricas/patologia
2.
Pulmonology ; 25(4): 223-235, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30509855

RESUMO

The diaphragm is the main breathing muscle and contraction of the diaphragm is vital for ventilation so any disease that interferes with diaphragmatic innervation, contractile muscle function, or mechanical coupling to the chest wall can cause diaphragm dysfunction. Diaphragm dysfunction is associated with dyspnoea, intolerance to exercise, sleep disturbances, hypersomnia, with a potential impact on survival. Diagnosis of diaphragm dysfunction is based on static and dynamic imaging tests (especially ultrasound) and pulmonary function and phrenic nerve stimulation tests. Treatment will depend on the symptoms and causes of the disease. The management of diaphragm dysfunction may include observation in asymptomatic patients with unilateral dysfunction, surgery (i.e., plication of the diaphragm), placement of a diaphragmatic pacemaker or invasive and/or non-invasive mechanical ventilation in symptomatic patients with bilateral paralysis of the diaphragm. This type of patient should be treated in experienced centres. This review aims to provide an overview of the problem, with special emphasis on the diseases that cause diaphragmatic dysfunction and the diagnostic and therapeutic procedures most commonly employed in clinical practice. The ultimate goal is to establish a standard of care for diaphragmatic dysfunction.


Assuntos
Diafragma/fisiopatologia , Nervo Frênico/fisiopatologia , Paralisia Respiratória/terapia , Ultrassonografia/métodos , Diafragma/diagnóstico por imagem , Diafragma/inervação , Diafragma/cirurgia , Eventração Diafragmática/complicações , Eventração Diafragmática/diagnóstico por imagem , Eventração Diafragmática/fisiopatologia , Fluoroscopia/métodos , Humanos , Microcirurgia/métodos , Nervo Frênico/lesões , Nervo Frênico/patologia , Nervo Frênico/cirurgia , Radiografia/métodos , Respiração Artificial/métodos , Respiração Artificial/tendências , Testes de Função Respiratória/métodos , Paralisia Respiratória/etiologia , Estimulação Elétrica Nervosa Transcutânea/métodos
3.
Can J Cardiol ; 34(12): 1688.e21-1688.e23, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30527167

RESUMO

Diaphragmatic eventration in old age is a rare phenomenon. Typically, it is thought to originate as a result of failure of development of the muscles of the diaphragm. Less commonly, it can occur secondary to acquired conditions resulting from spinal cord or phrenic nerve injury and is only detected incidentally when the patient presents with dyspnea, chest infection, or cardiac compression symptoms. Herein, we report a case of right diaphragmatic paralysis in a 58-year-old man with a presentation of marked elevation of the right hemidiaphragm and ascites causing a picture compatible with cardiac tamponade.


Assuntos
Tamponamento Cardíaco/etiologia , Eventração Diafragmática/complicações , Paralisia Respiratória/complicações , Ascite/diagnóstico por imagem , Tamponamento Cardíaco/diagnóstico por imagem , Eventração Diafragmática/diagnóstico por imagem , Ecocardiografia Transesofagiana , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
6.
Tunis Med ; 95(2): 136-138, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29424874

RESUMO

Congenital diaphragm eventration is a rare and usually asymptomatic developmental defect. Neonatal gastric perforation is also a rare but lifethreatening condition. In our knowledge, the association of these two pathologies has been, exceptionally reported. We report a case who illustrates clinical and radiological features of this possible co-morbidity. A full-term male neonate was born from uneventful pregnancy and delivery. The antenatal scan was reported as normal. At birth, clinical exam was normal, no special resuscitation was necessary. The newborn was examined and admitted the 4th day of life for fever, tachypnea, cyanosis, hemodynamic shock and refusing feeds. Clinical examination suggested peritonitis. Chest radiography and ultrasonography suggested congenital hernia. A laparotomy was performed after a brief resuscitation and confirmed the presence of diaphragm eventration with gastric perforation. Suturing of gastric perforation with a diaphragmatic plication was performed with favorable evolution.


Assuntos
Eventração Diafragmática/complicações , Hérnias Diafragmáticas Congênitas/complicações , Perfuração Espontânea/complicações , Gastropatias/complicações , Eventração Diafragmática/diagnóstico , Eventração Diafragmática/cirurgia , Hérnias Diafragmáticas Congênitas/diagnóstico , Hérnias Diafragmáticas Congênitas/cirurgia , Humanos , Recém-Nascido , Masculino , Perfuração Espontânea/congênito , Perfuração Espontânea/diagnóstico , Perfuração Espontânea/cirurgia , Gastropatias/congênito , Gastropatias/diagnóstico , Gastropatias/cirurgia
8.
Surg Technol Int ; 28: 222-5, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27175808

RESUMO

Elevated diaphragm can be due to diaphragmatic eventration or diaphragm paralysis. Diaphragm paralysis is a rare condition that can be congenital or acquired. Acquired diaphragmatic paralysis can result from injury to the phrenic nerve. Subsequently, there is loss of contractility of the diaphragm muscle leading to progressive atrophy and, hence, distension of the dome of the diaphragm leading to elevated right, left, or both copula of the diaphragm. Diaphragm plication aims to return the abdominal contents back to their normal position and allow for greater lung expansion by reducing the abundant diaphragmatic surface. Traditionally, diaphragm plication was performed through thoracotomy, until 1996 when Moroux introduced the widely used thoracoscopic technique of diaphragm plication. With the advancement of minimally-invasive surgery over the years, the approach to diaphragm plication has evolved from four ports to an uniportal approach and robotics.


Assuntos
Eventração Diafragmática/cirurgia , Laparoscopia/métodos , Paralisia Respiratória/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Cirurgia Torácica Vídeoassistida/métodos , Toracotomia/métodos , Eventração Diafragmática/complicações , Eventração Diafragmática/diagnóstico por imagem , Medicina Baseada em Evidências , Humanos , Paralisia Respiratória/diagnóstico por imagem , Paralisia Respiratória/etiologia , Resultado do Tratamento
9.
Fam Syst Health ; 34(1): 64-6, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26963780

RESUMO

Healing rituals and ceremonies are conducted with the hope of ushering a sick or impaired person back to wellness or preserving health against perceived threats (Burns, 1996). In medical settings, healing ceremonies can address biopsychosocial, existential, and spiritual aspects of difficult situations (Hammerschlag, 1989; Johnson, Feldman, Lubin, & Southwick, 1995; Mehl-Madrona, 1999). This article describes presents the case history of Lisa H. and her son, Anthony. Anthony experienced two medical crises within the first five days of his birth. The author suggested a healing ceremony might be valuable for Anthony's family. The ceremony opened the door to a candid conversation regarding everything that had transpired. It decreased the family's fear, anxiety, frustration, and guilt, and helped them cope better with the situation. Anthony sailed smoothly through his surgery and went home from the hospital a week later. The author notes that health care professionals generally set aside their spirituality while trying to help people, thus broaching the subject of ceremonies might make the care provider or the family feel uncomfortable. Care providers who are uncomfortable with participating could still provide a valuable service by presenting the notion of a ceremony as an option the patient or family may wish to consider, and directing them to useful resources.


Assuntos
Eventração Diafragmática/complicações , Espiritualidade , Adulto , Ansiedade/psicologia , Ansiedade/terapia , Comportamento Ritualístico , Eventração Diafragmática/cirurgia , Feminino , Florida , Humanos , Recém-Nascido , Masculino , Assistência Centrada no Paciente/métodos , Respiração Artificial/métodos
11.
Thorac Cardiovasc Surg ; 64(8): 631-640, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26720705

RESUMO

Introduction Diaphragmatic eventration is a congenital defect of the muscular portion of a hemidiaphragm that eventually leads to hemidiaphragmatic elevation and dysfunction. The clinical diagnosis of diaphragmatic eventration or diaphragmatic paralysis may be indistinguishable and diaphragmatic plication is the treatment of choice for both conditions. Discussion We review the indications, patient selection, and surgical techniques for diaphragmatic plication. We explain our preferred technique and guide the reader step by step on our approach. Conclusion Minimally invasive diaphragm plication techniques are effective alternatives to open transthoracic plication and result in significant improvement in dyspnea and quality of life in adequately selected patients.


Assuntos
Diafragma/cirurgia , Eventração Diafragmática/cirurgia , Laparoscopia/métodos , Paralisia Respiratória/cirurgia , Procedimentos Cirúrgicos Torácicos/métodos , Diafragma/anormalidades , Diafragma/inervação , Eventração Diafragmática/complicações , Eventração Diafragmática/diagnóstico , Eventração Diafragmática/fisiopatologia , Dispneia/etiologia , Dispneia/fisiopatologia , Humanos , Laparoscopia/efeitos adversos , Seleção de Pacientes , Valor Preditivo dos Testes , Qualidade de Vida , Recuperação de Função Fisiológica , Paralisia Respiratória/diagnóstico , Paralisia Respiratória/etiologia , Paralisia Respiratória/fisiopatologia , Fatores de Risco , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Resultado do Tratamento
12.
Cir Cir ; 84(2): 140-3, 2016.
Artigo em Espanhol | MEDLINE | ID: mdl-26238590

RESUMO

BACKGROUND: Acute gastric volvulus is a rare, but potentially life-threatening, cause of upper gastrointestinal obstruction. CLINICAL CASE: Male of 60 years old with severe epigastric pain and abdominal distension with haematemesis on two occasions. The patient was haemodynamically stable, with abdominal distension and palpable epigastric fullness. Hematic cytology showed: haemoglobin 8.2g/dl and haematocrit 27%. Abdominal X-ray showed an elevation of left diaphragm with a hugely dilated stomach. A nasogastric tube was inserted. Endoscopy was performed. There was no active bleeding, but it was impossible to reach the duodenum due to the stomach distortion. The upper gastrointestinal X-ray study showed the appearance of an inverted stomach in the chest and an organoaxial gastric torsion. The CT scans of thorax and abdomen showed a gastric ascent into the thoracic cavity. Laparoscopic surgery was performed, finding the left hemi-diaphragm elevated, and the stomach, splenic angle of the colon, the spleen and tail of the pancreas were also raised. A linear gastrectomy (gastric sleeve) was performed. The postoperative progress was satisfactory. Oral feeding was started 72 hours after surgery, and the patient was discharged, and has remained asymptomatic during the following by 8 years. CONCLUSIONS: Emergency physicians must maintain a high level of suspicion in patients that present with signs and symptoms suggesting upper digestive tract occlusion. The gastric sleeve is an excellent alternative to avoid recurrence of gastric volvulus.


Assuntos
Eventração Diafragmática/complicações , Gastrectomia/métodos , Laparoscopia , Volvo Gástrico/etiologia , Volvo Gástrico/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade
13.
Asian J Surg ; 39(2): 59-65, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26117205

RESUMO

BACKGROUND: Diaphragm plication surgery is conducted to remove dyspnea, which results from mediastinal shift, atelectasia, and ventilation/perfusion dyssynchrony in lungs that occur because of an eventrated diaphragm. This study aims to determine whether diaphragm plication has any effect on respiration by analyzing the patients' changing values in the respiratory function test (RFT) after plication surgery. METHODS: Sixteen patients who underwent diaphragm plication surgery in our clinic because of plication eventration or paralysis were examined prospectively. Diaphragm eventration values were assessed using a calculation method that uses posteroanterior pulmonary radiographies taken during patient admission and control; then, these data were recorded. The amount of changes in the eventration levels and in restrictive respiratory failure parameters-forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC) of RFTs-conducted in pre- and postoperative control periods were compared using statistical analysis methods. The compatibility between the amounts of RFT changes was examined through a satisfaction survey-using a questionnaire that consisted of multiple choice questions with answer options such as "better," "the same," and "worse"-to understand preoperative and postoperative symptom levels in the 12(th) month of postoperative control. RESULTS: According to postoperative levels, a decrease between 19% and 23% was observed in eventration amounts within the 1(st) postoperative month, 6(th) postoperative month, and 12(th) postoperative month. In addition, the highest average increase in FEV1 liter (lt) values was 0.2 lt and 0.25 in FVC (lt) values. CONCLUSION: Researchers of this study believe that more distinctive decisions need to be taken while identifying patients for surgery in unilateral diaphragm eventrations, especially in the adult patient group; surgical option should be used for cases in which the eventrated diaphragm results in mediastinal shift and respiratory failure.


Assuntos
Eventração Diafragmática/cirurgia , Pneumopatias/cirurgia , Adulto , Idoso , Eventração Diafragmática/complicações , Dispneia/etiologia , Feminino , Humanos , Pneumopatias/diagnóstico , Pneumopatias/etiologia , Masculino , Pessoa de Meia-Idade , Testes de Função Respiratória
15.
BMJ Case Rep ; 20152015 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-25976306

RESUMO

Rupture of the diaphragm may be traumatic or spontaneous. A spontaneous rupture occurring in a congenital eventration of the diaphragm is extremely rare. Only one such case has been reported previously. We report a case of a 5-month-old male infant who presented with acute life-threatening respiratory distress secondary to spontaneous rupture of a congenital diaphragmatic eventration.


Assuntos
Eventração Diafragmática/complicações , Eventração Diafragmática/diagnóstico , Diagnóstico Diferencial , Eventração Diafragmática/cirurgia , Dispneia/etiologia , Humanos , Lactente , Masculino , Ruptura Espontânea , Resultado do Tratamento
17.
J Pediatr Surg ; 50(7): 1088-92, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25783408

RESUMO

OBJECTIVE: This study sought to summarize the diagnostic and treatment aspects of congenital diaphragmatic eventration (CDE) in children by retrospectively analyzing their medical records to identify and understand the complications of CDE, its treatment, and to evaluate the long-term outcomes of diaphragmatic plication. METHODS: The medical records of children who received treatment for CDE from January 2000 to December 2011 at the Children's Hospital of Chongqing Medical University, China were analyzed. Data analyzed included the following: age, sex, symptom, location of eventration, associated anomalies, surgical procedures, complications, and survival and follow up details after diaphragmatic plication. RESULTS: The medical records of 177 children (boys: 128, girls: 49, mean age: 10.28±2.35 months) with CDE were included in this study. Specific symptoms of eventration of the diaphragm were reported for 86 cases; and the typical symptoms included rapid breathing, vomiting, and recurrent respiratory infections. Except for a bilateral case, all the other patients had unilateral CDE. Associated malformations were observed in 31 cases (17.5%), hypoplastic lung (10 cases) was the most common followed by congenital heart disease (9 cases), and cryptorchidism (3 cases). Interestingly, 91 patients were asymptomatic. Diaphragmatic plication was performed in all symptomatic patients (86 cases, 48.5%) and none had recurrence. CONCLUSIONS: Clinical symptoms of CDE varied in severity, ranging from asymptomatic conditions to life-threatening respiratory distress. Timely accurate diagnosis and treatment of symptomatic CDE could effectively resolve respiratory morbidity and reduce complications. The diaphragm plication surgery provided good results among the study population with no recurrence.


Assuntos
Eventração Diafragmática/complicações , Anormalidades Múltiplas , Adolescente , Doenças Assintomáticas , Criança , Pré-Escolar , China , Criptorquidismo/complicações , Diafragma/cirurgia , Eventração Diafragmática/cirurgia , Dispneia/etiologia , Feminino , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/cirurgia , Herniorrafia , Hospitais Pediátricos , Humanos , Lactente , Pulmão/anormalidades , Masculino , Recidiva , Estudos Retrospectivos , Vômito/etiologia
19.
Rev Iberoam Micol ; 32(2): 118-21, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-24863142

RESUMO

A case of fungemia with interstitial lung compromise caused by Malassezia sympodialis is reported in an obese pediatric patient on long-term treatment with inhaled corticosteroids for asthma. The patient was hospitalized due to a post-surgical complication of appendicitis. The patient was treated with amphotericin B for 3 weeks, with good clinical evolution and subsequent negative cultures.


Assuntos
Fungemia/microbiologia , Pneumopatias Fúngicas/microbiologia , Doenças Pulmonares Intersticiais/microbiologia , Malassezia/isolamento & purificação , Complicações Pós-Operatórias/microbiologia , Anfotericina B/uso terapêutico , Antibacterianos/uso terapêutico , Antifúngicos/uso terapêutico , Apendicectomia , Asma/complicações , Criança , DNA Fúngico/genética , Diagnóstico Tardio , Eventração Diafragmática/complicações , Eventração Diafragmática/cirurgia , Fungemia/diagnóstico , Fungemia/tratamento farmacológico , Humanos , Pneumopatias Fúngicas/diagnóstico , Pneumopatias Fúngicas/tratamento farmacológico , Doenças Pulmonares Intersticiais/diagnóstico , Doenças Pulmonares Intersticiais/tratamento farmacológico , Malassezia/classificação , Malassezia/genética , Masculino , Técnicas de Tipagem Micológica , Obesidade/complicações , Polimorfismo de Fragmento de Restrição , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/tratamento farmacológico , Tinha Versicolor/complicações , Tinha Versicolor/diagnóstico , Tinha Versicolor/tratamento farmacológico , Tinha Versicolor/microbiologia
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