Congenital diaphragmatic hernia: a comparative study of two different strategies of management

Although, the current trends recommend delayed surgical repair for the management of neonates with high risk congenital diaphragmatic hernia [CDH], there is still a debate regarding the optimal ventilator strategy used for the management of neonates with CDH. We aimed to evaluate and compare the outcome of conventional ventilatory approach versus gentle ventilation with permissive hypercapnea used for the management of neonates with CDH. Seventy eight neonates with CDH involved in this study, divided into two groups: Group I [n= 40] were treated with conventional ventilation, while group II [n=35] were ventilated with gentle ventilation with permissive hypercapea. Both groups were evaluated as regard to surgical repair, duration of ventilation dependency, length of hospital stay, incidence of preoperative and postoperative pneumothorax, duration of oxygen dependency, incidence of early [< 2 months] and late [> 2 months] mortality, and survival at 6 months. Surgical repair was done in 70 neonates [89.7%], 35 neonates in each group. A prosthetic diaphragmatic patch was used in 21.4% of neonates. Neonates in group II had significantly earlier surgical repair than in group I [68.43 +/- 16.50 vs. 115.23 +/- 23.13 hours], significantly shorter ventilation time [9.6 +/- 2.1 vs. 14.3 +/- 3.6 days]. The survived neonates of group II were significantly discharged out of the hospital earlier than those in group I [23.4 +/- 3.9 vs 30.5 +/- 4.3days]. The incidence of preoperative pneumothorax was significantly lower in group II than in group I [13.1% vs. 30%]. The overall survival rate at 6 months was nearly similar for infants in both groups [81.5% in group II compared to 77.5% in group I]. Five neonates in group I and 3 in group II died before surgery due to severe respiratory failure, associated cardiac problems or cerebral hemorrhage. Twenty percent of infants in group II were still O[2] dependent at the age of 30 days compared to 14.2% in group I with non significant difference. At the age of 6 months only 5.7% of infants in each group were still O[2] dependent. Neonates ventilated using gentle ventilation with permissive hypercapnea had a shorter time before surgery with earlier withdrawal of ventilation and earlier discharge out of the hospital with less incidence of preoperative pneumothorax but with nearly equal mortality and survival rates when compared with neonates ventilated with the conventional ventilation

Experimental functional evaluation of bladder augmentation using demucosulated gastrocystoplasty compared to myotomy and myomyectomy

This study was conducted on 30 dogs divided into three equal groups: Group I underwent vesicomyotomy, group II had vesicomyectomy and group III had vesicomyectomy with demucosulated gastrocystoplasty. All groups were compared pre-and postoperatively as regards bladder capacity, pressure and compliance. The mortality and postoperative complications were recorded. The study concluded that the functional evaluation of various techniques for bladder auto-augmentation showed that bladder capacity increased with a better compliance and without any metabolic complications related to the presence of gastrointestinal mucosa in the augmented unit. The addition of a seromuscular gastric patch to vesicomyectomy improved the functional results and decreased the incidence of complications

Idiopathic isolated gastro intestinal perforation in the newborn

Idiopathic neonatal gastro intestinal perforations has been recently recognized as an individual entity. Absence of prodroma of typical enterocolitis makes diagnosis more difficult. We present 16 cases reviewed from 1997 to 1999, in Ain Shams University Hospitals. The perforations were three in the stomach, three in the duodenum, two in the duodeno jejunal junction, five in the ileum and three in the colon. Survival rate was 75% after surgical exploration. Enterostomies yielded a better result than primary anastomosis. Mortality [4 cases, 25%] was found to be related to the site of perforation and the time of recognition. Follow up of 7 patients showed no long term sequelae, which differentiates the condition from classic NEC