Imperforate anus, diaphragmatic hernia, horseshoe kidney, and pulmonary sling complex: case description

This report describes an infant with imperforate anus, delayed presentation of congenital diaphragmatic hernia, horseshoe kidney, and pulmonary sling complex, a unique combination of anomalies that we recently treated at our facility.     

Mathematical model of chest wall mechanics: A phenomenological approach

A mathematical model of chest wall mechanics, based on a phenomenological approach to force balances, provides a quantitative framework for analyzing many types of chest wall movements by using orthogonal displacement coordinates. The moveable components of the ventilatory system include the rib cage, diaphragm, and abdomen. A distinction is made between the lung-apposed and diaphragm-apposed actions on the rib cage. The model equations are derived from “pressure” balances and geometrical relations of the compartments; the stress-displacement relations are hyperbolic. With this model we simulated stiff and flaccid chest wall behavior under normal and constrained conditions associated with abdominal compression, a Mueller maneuver, and a diaphragmatic isometric inspiration. We also examined situations that produce paradoxical as well as orthodox inspiratory movements. The results of these simulations were quantitatively consistent with available data from the literature. A phenomenon predicted by the stiff-wall model during quasi-static inspiration is that the rib cage displacement is negligible near residual volume, but then increases dramatically with lung volume. Since this mathematical model has a sound physical basis and is more comprehensive than previous models, it can be used to predict and analyze the behavior of the chest wall under a wide variety of circumstances.     

Hernia diafragmática tras radiofrecuencia de metástasis hepática. Reporte de caso clínico y revisión de la literatura

A diaphragmatic hernia is the protrusion of abdominal tissues into the thoracic cavity secondary to a defect in the diaphragm. Reviewing the literature, we found only 44 references to diaphragmatic hernia secondary to percutaneous radiofrequency treatment. The vast majority of these cases were secondary to the treatment of hepatocellular carcinoma in segments V and VIII. Nevertheless, to date, this is the first reported case of diaphragmatic hernia after radiofrequency ablation of a liver metastasis from colorectal cancer. Complications secondary to diaphragmatic hernias are very diverse. The principal risk factor for complications is the contents of the hernia; when small bowel or colon segments protrude in the thoracic cavity, they can become incarcerated. Asymptomatic cases have also been reported in which the diaphragmatic hernia was discovered during follow-up. The pathophysiological mechanism is not totally clear, but it is thought that these diaphragmatic hernias might be caused by locoregional thermal damage. Given that most communications correspond to asymptomatic and/or treated cases, it is likely that the incidence is underestimated. However, due to the advent of percutaneous treatments, this complication might be reported more often in the future. Most cases are treated with primary herniorrhaphy, done with a laparoscopic or open approach at the surgeon's discretion; no evidence supports the use of one approach over the other. Nevertheless, it seems clear that surgery is the only definitive treatment, as well as the treatment of choice if complications develop. However, in asymptomatic patients in whom a diaphragmatic hernia is discovered in follow-up imaging studies, management should probably be guided by the patient's overall condition, taking into account the potential risks of complications (contents, diameter of the opening into the thoracic cavity …).     

Examining the contribution of surrounding intact skin during cutaneous healing

Severe cutaneous wounds expose the body to the external environment, which may lead to impairments in bodily functions and increased risk of infection. There is a need to develop skin substitutes which could effectively promote complete skin regeneration following an injury. Murine models are used to test such skin substitutes, but their healing involves contraction of the dermis not found in human wounds. We have previously described a device called a dome, which comes in two models, that is used to prevent skin contraction in mice. One model provides a physical barrier to minimize contraction, and the other model has additional perforations in the barrier to allow cellular contribution from the surrounding intact skin. Taking advantage of an enhanced version of these two models, we compared granulation tissue formation, the extent of vascularization, and the transition to myofibroblastic phenotype between the models. We enhanced the dome by developing a twist open cap dome and applied the two models of the dome into the excisional wound biopsy in mice. We demonstrate that the dome can be used to prevent skin contraction in mice. The control model prevented skin contraction while barricading the contribution of surrounding intact skin. When not barricaded, the intact skin enhances wound healing by increasing the number of myofibroblasts and neovascularization. Using a novel model of inhibition of skin contraction in rodents, we examined the contribution from the surrounding intact skin to granulation tissue formation, myofibroblastic differentiation, and neovascularization during the course of skin healing in mice.     

四逆汤对家兔膈肌疲劳的保护作用

目的 观察四逆汤对家兔膈肌疲劳的保护作用。方法 家兔乌拉坦麻醉,耳静脉注射油酸０．１ｍｌ／ｋｇ复制膈肌疲劳模型,剑突下分离膈肌条。分别记录膈肌收缩力及电活动变化。结果 腹腔注射四逆汤（２ｍｌ／ｋｇ）后可使正常家兔膈肌收缩力增（Ｐ〈０．０１）,膈肌放电积分曲线峰值（ｐｅａｋ）、积分曲线斜率（ｓｌｏｐ）增加（Ｐ〈０．０１）;复制膈肌疲劳后,腹腔注射四逆汤（２ｍｌ／ｋｇ）,可使疲劳膈肌收缩力增加（Ｐ〈０     

创伤性膈疝28例临床分析

目的总结创伤性膈疝的诊治经验。方法回顾分析1990年1月～2004年8月28例创伤性膈疝临床资料。其中开放性损伤7例,闭合性损伤21例。结果术前确诊19例（67．9％）,治愈25例。死亡3例（10．7％）,2例死于出血性休克,1例死于多器官功能障碍综合征（MODS）。结论胸部X线和CT检查是诊断创伤性膈疝的重要方法。早期诊断、及时手术,正确处理合并脏器伤是提高治愈率的关键。     

创伤性膈肌破裂67例临床分析

目的：探讨创伤性膈肌破裂（TDR）的临床特点。方法：回顾分析1998年7月～2009年10月我院收治的67例TDR病例资料。结果：TDR患者男51例,女16例;本组患者损伤严重度评分为（21.3±8.1）分;TDR左侧59例、右侧7例、双侧1例;65例伴有胸、腹腔脏器损伤,46例伴膈疝形成;60例术前有影像学检查结果。67例均行急诊手术治疗。CT对TDR诊断符合率为69.8%。TDR术前诊断率64.2%。62例治愈,无并发症发生,死亡5例。结论：对创伤性TDR患者,应重视TDR发生原因,早期诊断,适时掌握TDR的手术时机,正确选择处理顺序、手术入路和修补方式,能提高救治成功率和降低并发症发生率。     

创伤性膈疝误诊漏诊原因分析（附8例报告）

目的：探讨创伤性膈疝误诊漏诊的原因,方法：回顾性分析１９７６～１９９６年８例创伤性膈疝并结合有关文献进行探讨。结果：全组患者术前确诊５例,术前未明确膈肌破裂,因其它原因手术而确诊３例,结论：创俐性膈疝的诊断主要依靠临床动脉观察和Ｘ线的特异表现为追踪观察。     

医源性膈疝MSCT多平面重组表现

目的 分析食管癌术后继发医源性膈疝(IDH)的MSCT多平面重组(MPR)表现,探讨其诊断价值.方法 回顾性分析2010年1月至2014年3月间食管癌术后继发IDH 16例.将其CT号随机混编入其他50例食管癌术后无食管裂孔(EH)扩大患者队列,由2名不知研究目的从事腹部影像诊断的高年资医师分别就横断位和MPR图像进行判断.对不同医师、不同方法判断结果及影像表现差异采用x2检验.结果 16例IDH中3例局限性于EH,横断位2例呈假“肠套叠”征,1例呈肠扭转表现;MPR直观显示肠管挤入EH顶压胸腔胃呈“壁贴壁征”.13例超出EH范围,横断位表现为胸腔内肠管于各方向汇聚于EH处胸腔胃,其中,前外、后外及前后外侧分别为9例、5例和2例,前外侧明显多于前后外侧(x2 =6.79,P＜0.05),2例并肠系膜扭转;MPR直观显示胸腔内管肠及其系膜血管通过EH与腹腔相应结构连通.由2名医师横断位提示IGH诊断分别为3例和4例,MPR全部提示IDH诊断,均显著高于横断位(x2=21.89,19.20,P值均＜0.05).结论 食管癌术后继发IDH横断位表现隐匿,仔细观察并及时辅以MPR,对诊断具有重要意义.