[First case report in Mexico of a diaphragmatic hernia, by Agustín Arellano in 1839]. / Hernia diafragmática. primer caso informado en México por el doctor Agustín Arellano en 1839.

Reports on partial lacking of the diaphragm and diaphragmatic hernia date to seventeenth century reports. In 1939 Arellano published in Mexico, a necropsy case of diaphragmatic hernia with holoprosencephaly and cyclocephaly. Agustín Arellano's was the the fifth or sixth report ever published worldwide and his manuscript was reported nine years before Bochdalek's publication. Before 1839, in the Americas, there is no other existing report describing this type of pathology, and we can safely assume Arellano's work was the first of its kind in the Western hemisphere. It is well known that, at the time, the quality ofscientific publications of this Mexican medical researcher could be compared to the level of any medical publication in the developed world. It is worth noting that the Journal were Arellano's work was published, named "Periodico de la Academia de Médicina de Mégico (sic), "founded and directed by Dr. Manuel Carpio in 1836, is the direct precursor of the present-day "Gaceta Médica de México" the oldest current medical journal in the Americas.

Congenital diaphragmatic hernia: where are we and where do we go from here?

The infant born with congenital diphragmatic hernia (CDH) remains one of the most complex patients to manage. Pulmonary hypoplasia and immaturity of the CDH lung are well recognized as the definitive limitation leading to the high mortality rates. Based on the knowledge that CDH is more a physiological disease than a surgical disease, we have shifted our management strategy from immediate repair to delayed repair and stabilization. The associated pulmonary hypertension and right-to-left shunt are common and rarely the cause of death and as such may be largely ignored. Extracorporeal membrane oxygen has been shown to salvage some of the most severely affected neonates. Other advanced and experimental respiratory therapies merit investigation in properly conducted prospective randomized multi-center trials. Survivors of CDH have predictable pulmonary, gastrointestinal and nutritional problems which, when identified and treated early, are correctable. CDH survival is close to 90% at most advanced centers. Uniform standards for CDH management do not exist however. Therefore a minimal set of practice standards should be developed from evidenced-based scientific review.

The history of congenital diaphragmatic hernia from 1850s to the present.

Congenital diaphragmatic hernia (CDH) is believed to result from incomplete fusion of the pleuroperitoneal membrane, and passage of the abdominal contents into the chest. A historical review of the literature on this subject shows a wide divergence of opinion on the etiology of the various types of CDH, and on the recommended treatment. A variety of theories regarding its causes and the optimal way of approaching it have been published from the mid 19th century through the 20th century, and are reviewed in this article.

Congenital diaphragmatic hernia. A historical review.

Congenital diaphragmatic hernia (CDH) has been described, studied, and treated for over 400 years. A historical perspective is given. Great strides have been made in the care of patients with CDH; however, the mortality rate remains 30% to 60%. Consideration of historical references, observations, and achievements in the study of CDH is important for the continued advancement and improvement in our understanding of and future success in treating infants and children with CDH.

[The first Polish report on congenital diaphragmatic hernia and visceral malrotations]. / Pierwszy polski opis przepukliny przeponowej oraz wad ulozenia narzadów.

The forgotten throughout the years the doctor dissertation from 1837 of the Polish physician Ludwik Przybylko entitled De pravo organorum situ ("About malposition of the human organs") was presented. This paper, excessively modern in its epoch, contains the compendium of the contemporary medical science of the organs' dislocation and malrotation (including heart malposition and coexisting defects). First of all, however, it is the well-scientifically documented case report on the diaphragmatic hernia in the newborn. The summarized historical review of scientific report on diaphragmatic hernia places a special emphasis on the reports that had been published before the dissertation of Przybylko and before the Bochdalek's historical report in 1848, since then the posterolateral defects of the diaphragm have been defined with that name. The extensive fragments of the dissertation translated from Latin into Polish have been cited. Ludwik Przybylko presented not only the clinical report and details of precise anatomopathological description of the newborn with diaphragmatic hernia, but he also cited the relevant literature and discussed the issue with thorough knowledge. Numerous clinical and anatomopathological remarks of the author, based on his own experience and accordingly applied literature, have been current until today. The case report is completed with four engraved illustrations (woodcut) that document the autopsy examination. The work contains extremely interesting and revolutionary for that time considerations on the evolution (22 years prior to the famous work of Darwin) with an attempt to locate the etiology of congenital diaphragmatic hernia in the evolution. The authors of this paper suggest that the dissertation of Ludwik Przybylko should be interesting for paediatric surgeons and, especially because of its unusual and original contents, ought to take constant place in the history of Polish and world's medicine.

Vincent Alexander Bochdalek (1801-1883).

Vincent Alexander Bochdalek, Czech anatomist and professor, was one of the pioneers in describing congenital diaphragmatic hernias in newborns. Interestingly, there is very little in the literature and almost nothing in the English literature regarding this important medical figure. A dedicated individual, Bochdalek had great perseverance, which allowed him to surpass obstacles in both his personal life and career. He is recognized for his accurate description of posterior diaphragmatic herniation, for which during his lifetime, there was no treatment. In addition, Bochdalek has multiple eponyms in his honor: ganglion Bochdalecki, Bochdalek's basket, and the valves of Bochdalek. Always steadfast in his beliefs, Bochdalek fought for the creation of anatomy labs in Prague against society pressures. His devoted study of anatomy, especially of congenital diaphragmatic hernias, laid the foundation for the successful surgical correction of this once lethal anomaly.

Morgagni's hernia: believing is seeing.

The original description by Morgagni of the anterior diaphragmatic defect that bears his name implies a paramedian defect and this may be true when acquired in adulthood. In contrast, the anterior diaphragmatic defect that is observed in children is central rather than paramedian, as is often assumed. Its central retrosternal location has been confirmed by various methods, but is most clearly evident on laparoscopy.

Holoprosencephaly in Mexico: first reported autopsy case by Dr. Agustín Arellano.

INTRODUCTION: Holoprosencephaly with cyclocephaly is an early disturbance of organogenesis and has been classified as a severe brain malformation starting in 1755 by Eller in Germany, then in 1822 by Etienne Geoffroy de Saint-Hilaire in France, and finally in 1828 by Tiedemann in Germany. In 1839, Dr. Arellano published in Mexico a necropsy case of holoprosencephaly. This was the fourth publication worldwide on this kind of pathological alteration. Furthermore, in reference to diaphragmatic herniation, Arellano's paper is the fourth world report, having appeared 9 years before Bochdalek's publication. We have not found any other report that appeared before 1839 in the Americas on this particular malformation, and we consider that Arellano's paper was the first of its kind on the American continent. CONCLUSION: As is well known, the publications of this Mexican medical researcher were, for his time, at the level of those of the most developed countries. It is also important to know that the medical journal where Arellano's work was published, the "Periódico de la Academia de Medicina de Mégico(sic)," founded and directed by Dr. Manuel Carpio in 1836, is the direct forerunner of the present Gaceta Médica de México, the oldest currently published journal in the Americas.

Historical aspects of congenital diaphragmatic hernia.

The first description diaphragmatic hernia appeared in 1575. In 1848, Bochdalek described congenital diaphragmatic hernia (CDH) occurring through a posterolateral defect. Successful surgical treatment of CDH in an infant was first performed in 1902, whereas the first neonate operated within 24 hours of life was reported in 1946. However, early surgery did not improve survival rates and the mortality was in the region of 50%. One reason for this was that more neonates underwent surgery who previously would have died without the repair of the CDH. Pulmonary hypoplasia and pulmonary hypertension were early recognised as important reasons for the high mortality rate. In recent years, an enormous effort has been made by research groups all over the world to describe the pathogenesis and pathophysiology of CDH, and apply these findings to clinical practice. Attempts have been made to define prognostic factors. Extracorporeal membrane oxygenation (ECMO) has produced encouraging results. Fetal surgical therapy remains an option in selected cases despite huge technical and ethical problems. Recently, several new therapeutic methods have been suggested, such as high frequency oscillatory ventilation, partial liquid ventilation, nitric oxide inhalation, surfactant therapy, and fetal tracheal ligation. However, more experience is required before the value of these approaches is clear. Despite these efforts, the mortality remains unacceptably high. The challenge for the future is to continue development of therapeutic approaches in order to improve survival of neonates with CDH.