Congenital diaphragmatic hernia: antenatal prognostic factors

Despite regular progress in neonatal intensive care, congenital diaphragmatic hernia (CDH) diagnosed antenatally is still associated with up to 80 % mortality. It is impossible to predict which fetus with CDH will survive or not. Objective: To identify reliable antenatal predictors of outcome and of pulmonary hypoplasia (PH) in fetuses with CDH. Design: Retrospective study. Setting: Paediatric intensive care unit of a university children's hospital. Patients and methods: Antenatal parameters and presence of left ventricular hypoplasia in utero were compared retrospectively to outcome and to presence of PH in 32 consecutive newborn infants with antenatally diagnosed CDH. Antenatal parameters included: gestational age at diagnosis, herniated organs, associated malformations and presence of polyhydramnios. Size of the cardiac ventricles, the aorta (Ao) and the pulmonary artery (PA) were obtained by fetal echocardiography, from which we calculated a cardioventricular index (left ventricle/right ventricle, LV/RV) and a cardiovascular index (Ao/PA). Delivery was planned in order to provide ventilatory and hemodynamic management. In case of death, PH was assessed according to the following criteria: the lung weight/body weight index and the radial alveolar count. For statistical comparisons, patients were separated into two groups: the hypoplasia group (H) and the non-hypoplasia group (NH). Results: Thirty-two pregnancies were delivered. Twenty-six newborns died (81 %), 6 survived (19 %). When comparing non-survivors to survivors, predictors of poor outcome were: mean gestational age at diagnosis (23 vs 28 weeks, p = 0.002), intrathoracic stomach (20 vs 1 s, p = 0.01) and associated malformations (6 vs 0). Cardiac ventricular disproportion, expressed by the LV/RV ratio, appeared to correlate well with a poor outcome (0.63 in non-survivors vs 0.93 in survivors, p = 0.03) and with PH (0.63 in the H group vs 0.95 in the NH group, p = 0.03). Conclusions: Our study confirmed the factors for a poor prognosis associated with CDH previously described in the literature, but none with a consistent demonstration of accuracy. LV hypoplasia may be a more accurate predictor of outcome and of PH but it has to be assessed by prospective studies with larger samples. Further basic science and Doppler-flow studies may be helpful to understand the natural history and pathophysiology of LV hypoplasia in CDH. Received: 4 November 1996 Accepted: 9 July 1997     

Amniocentesis for antenatal diagnosis

Midtrimester amniocentesis is currently the most widely employed technique to monitor fetuses for certain genetic risks. The procedure is generally regarded as safe. However, the small but significant risks must be understood by couples considering this procedure. The most common indications for genetic amniocentesis include advanced parental age, previous child with a chromosomal abnormality, a parental translocation or other chromosomal abnormality, certain Mendelian disorders, and a previous child with a neural tube defect.     

Maternal response to anomalies detected by antenatal ultrasonography

OBJECTIVE: To determine the effect of an atypical antenatal scan on the expectant mother. DESIGN: Postnatal postal questionnaire. SETTING: Questionnaires completed at home after the infants had been investigated at a regional paediatric surgical unit. SUBJECTS: Twenty-nine mothers. RESULTS: The mothers had a very positive attitude to antenatal ultrasonography. The information that the scan was atypical resulted in a high level of parental anxiety which sometimes persisted into the postnatal period. CONCLUSION: A multidisciplinary approach is required for the management of the expectant mother who has an atypical scan.     

胎儿腹部囊性包块的产前超声诊断与鉴别诊断

目的 探讨胎儿腹部囊性包块的声像特征,提高超声对胎儿腹部囊性包块的诊断及鉴别诊断价值.方法 收集2010年1月至2012年12月间我院产前超声检查发现胎儿腹部囊性包块并有随访结果的病例192例,分析不同孕周、不同来源囊性包块的声像特征、发生部位及动态变化,对照产后结果进行分析.结果 产前超声诊断与产后结果符合175例,其中肝脏来源10例,胆道来源8例,肠道来源39例,肾实质来源32例,泌尿系梗阻来源41例,生殖系统来源38例,其他来源7例;超声诊断符合率为91.1％ （175/192）.首次超声检查发现包块的时间主要集中于18～ 32周之间,中位孕周为25周.18周以前以巨膀胱多见,晚孕期以卵巢囊肿、低位消化道梗阻和输尿管扩张为主.产前超声误诊17例,误诊率为8.9％.产前超声对肠道来源的囊性包块误诊率较高,为5.7％,对生殖系统及其他来源误诊率较低,均为0.5％.结论 超声依据胎儿腹部囊性包块的发生部位、形态、内部回声、血流情况、与周围器官的毗邻关系、与孕周的关系等情况判断囊性包块的来源,对胎儿的评估有重要的临床指导意义.     

创伤性膈肌破裂的诊断与治疗

目的探讨创伤性膈肌破裂早期诊断和治疗的方法。方法回顾性分析19例创伤性膈肌破裂的临床资料。闭合性损伤14例,开放性损伤5例。5例由胸部X线片确诊,11例由胸部CT确诊,3例经手中探查确诊。结果16例患者于术前得到确诊;18例患者经积极手术治疗均治愈,1例患者因严重肝破裂失血性休克死亡。术后并发出现肺不张1例,膈下脓肿1例,经积极治疗后治愈。结论增强对创伤性膈肌破裂的认识,详细采集病史及查体,通过胸部X线片或CT及时诊断和手术修补破裂的膈肌是提高治愈率及减低并发症的关键。     

Sonographic antenatal diagnosis of congenital dacryocystoceles

Congenital dacryocystoceles are a relatively rare variant of nasolacrimal duct obstruction, accounting for only 0.1% of infants with congenital nasolacrimal duct obstruction. We report a new case of bilateral congenital dacrocystoceles diagnosed in an otherwise uncomplicated fetal ultrasound examination during the 33rd week of pregnancy. The diagnosis was confirmed postnatally. The neonate, who did not present postpartum respiratory distress, was scheduled for endoscopic marsupialization-probing of the cystic structures. Parents must be well informed about the risk of respiratory distress, and facial appearance. Complete resolution is achieved after surgical intervention.     

MSCT诊断创伤性膈疝

创伤性膈疝是一种并不常见的胸腹外科急症,以往多通过X线检查,但检查繁琐,患者多不配合,误诊、漏诊常见.随着CT的普及,有关CT对创伤性膈疝的诊断应用逐渐见诸报道,但对MSCT研究报道较少.笔者收集手术证实的创伤性膈疝9例,分析、总结其MSCT的特征性表现,探讨MSCT对创伤性膈疝的诊断价值,旨在提高MSCT对创伤性膈疝的诊断率,为临床手术治疗提供更为详细直观的影像信息.     

Delayed diagnosis of right-sided diaphragmatic rupture

Diaphragmatic rupture is uncommon and results from either blunt or penetrating trauma. Right-sided traumatic diaphragmatic ruptures are easily missed. We present a case of rupture of the right diaphragm, which highlights the difficulty of confirming the correct diagnosis.     

产前超声诊断教学的体会

产前超声诊断作为降低出生缺陷的一种重要手段越来越受到重视。我们以解剖学和组织胚胎学为基础,以多媒体教学为主要手段,同时与病理和临床相结合,使学员对疾病形成直观印象,加深理解,从而达到提高产前超声诊断教学质量的目的。     

The antenatal diagnosis of hyperplacentosis, hydramnios and fetal ascites.

The diagnostic value of volumetric analysis of the products of conception by compound ultrasonic scanning is illustrated by a case of hyperplacentosis, hydramnios, and fetal ascites. The use of this method in the diagnosis of fetal conditions is discussed.     

Chronic diaphragmatic hernia. A difficult diagnosis

Chest pain is commonly caused by disorders of the heart, lungs, and chest wall. Pinpointing the exact cause is often a diagnostic challenge. In this article, the authors describe the evaluation and treatment of a patient with sharp chest pain of unusual origin.