Diaphragmatic flutter.

A case is reported of diaphragmatic flutter with an unusually long duration of symptoms. The patient described demonstrates many of the classical features of this disorder.     

创伤性膈肌破裂及膈疝的诊治体会

目的：探讨创伤性膈肌破裂及膈疝的临床特点及治疗方法。方法：对32例创伤性膈肌破裂和膈疝的病例进行回顾性分析。结果：单纯膈肌破裂6例,左侧膈疝15例,右侧膈疝8例,双侧膈疝3例。单纯膈肌破裂经B超确诊4例,右侧膈疝术前确诊5例,双侧膈疝术前确诊1例,余病例经术中、X线及CT等确诊。死亡2例。结论：创伤性膈肌破裂及膈疝易漏诊和误诊,术前制定合理的治疗方案可降低并发症及死亡率。     

Congenital Diaphragmatic Hernia in the Newborn

A ten year review (1980–1989) of 59 neonates presenting with congenital diaphragmatic hernia (CDH) to Our Lady’s Hospital for Sick Children, the main referral centre for neonatal surgery in Ireland, is presented to determine the outcome and make suggestions for improvements. CDH was more common in males (34M, 25F). The hernia was present on the left side in 47 cases and 11 cases were right sided. Overall mortality was 35.6%, with increased mortality for right-sided hernia (54.5%). Mean gestation period for survivors was 39 weeks and for non-survivors was 36 weeks. Fifty-two (88.1%) patients presented with symptoms within first six hours after birth. Nineteen of 59 patients (32%) did not have their airways secured with an endotracheal tube at the time of arrival in the hospital. Recurrent chest infections and gastro-oesophageal reflux were the most common long term complications. The prognosis was better for late presenters. A period of prolonged ventilatory stabilisation with appropriate inotropic support to help correct acidosis before surgery improved results. Surgery should be postponed until ventilatory stabilisation is established. A protocol for safe transport of patients to the referrral centre is recommended. It is advisable that all patients with congenital diaphragmatic hernia be intubated as soon as the diagnosis is made and that a doctor accustomed to airway management accompanies the patient to the neonatal surgical centre.     

Diaphragmatic paralysis following cervical herpes zoster

A 74-year-old man was found to have a paralysed left hemidiaphragm within four months of the appearance of a typical herpes zoster rash involving his left shoulder and neck. Investigations, including bronchoscopy and computed tomography of the chest, failed to detect a cause for the diaphragmatic paralysis. We believe that the cervical zoster and diaphragmatic paralysis were causally related, a rare but recognised association.     

锐器穿通性膈肌破裂的CT征象

目的探讨螺旋CT及多层螺旋CT对锐器穿通性膈肌破裂的诊断价值。方法对2007年4月至2012年2月在我院住院,并经临床及手术证实的22例急性创伤性锐器穿通伤膈肌破裂患者的CT图像进行回顾性分析。其中右侧膈肌破裂7例,左侧膈肌破裂15例,未见双侧膈肌同时破裂病例。结果锐器穿通性膈肌破裂的征象包括膈肌不连续(裂口征)9例,弹道征8例,膈肌增厚8例,腹腔脏器疝入胸腔7例,狭颈征2例,内脏坠落征6例,肋膈窦闭塞征3例,同时出现的胸腹腔积血7例,无上述阳性CT征象3例。结论穿通性膈肌破裂CT征象较隐匿,直接征象与间接征象相结合,是提高膈肌破裂CT诊断率的前提。     

膈肌损伤诊断与治疗体会

临床工作中，胸腹联合伤较常见。多数患者经正确诊治可痊愈，部分患者因病情复杂，特别合并膈肌损伤，因不能及时准确诊断，贻误手术治疗时机。预后不佳甚至危及生命。本文对合并膈肌损伤的胸腹联合伤病例如何及时准确诊断及治疗体会作一报道。