Bubaline Diaphragm Matrix: Development and Clinical Assessment into Cattle Abdominal Hernia Repair

Abstract The purpose of the study was to develop a xenogenic bubaline diaphragm matrix (BDM) for abdominal hernia repair. A fresh diaphragm was decellularized using aqueous sodium dodecyl sulfate (SDS) solutions (0.5-4% w/v) over a period. Acellularity was confirmed histologically and characterized by Masson's trichrome staining, scanning electron microscopy (SEM), DNA quantification, agarose gel electrophoresis, and Fourier-transform infrared spectroscopy. The BDM was used for clinical abdominal hernia repair in six cattle. Clinical, hemato-biochemical and antioxidant parameters were evaluated to assess biocompatibility of xenogenic BDM. Histologically, the diaphragm treated with 2% SDS for 48 h showed complete acellularity and orderly arranged collagen fibers. The SEM confirmed preservation of collagen structure and integrity. The DNA content was significantly (P < 0.05) reduced in BDM (33.12 ± 5.40 ng/mg) as compared to the native diaphragm (443.96 ± 162.60 ng/mg). DNA extracts from BDM show considerable removal of DNA material, with absence of DNA band in agarose gel. The FTIR spectrum of BDM has shown all characteristic transmittance peaks of bovine skin collagen indicating preserved collagen structure. Six cattle with BDM implant recovered uneventfully and remained sound at least upto 6 months. Hemato-biochemical and antioxidant findings were unremarkable. Bubaline diaphragm matrix shows excellent repair efficiency and biocompatibility for abdominal hernia repair in cattle without complications.

Secuestro pulmonar extralobar infradiafragmático: a proposito de un caso / Extralobar Infradiaphragmatic Pulmonary sequestration: a case report

Se presenta un caso de secuestro pulmonar extralobar infradiafragmático como hallazgo ultrasonográfico prenatal, confirmado posteriormente por anatomía patológica.

We present a case of extralobar infradiaphragmatic pulmonary sequestration as prenatal ultrasonographic finding, subsequently confirmed by histopathology.

Incomplete small bowel obstruction caused by idiopathic diaphragm disease of the proximal ileum

Diaphragm disease is a rare pathology and describes the phenomenon of circumferential, concentric mucosal lesions of the bowel which can cause progressive narrowing of the bowel lumen and bowel obstruction. The etiology in significant majority of cases is previous or concurrent ingestion of non-steroidal anti-inflammatory drugs [NSAID]. A 55-year-old Caucasian man with no history of prior ingestion of NSAID presented with a three week history of progressive abdominal pain, distension and subsequent absolute constipation. He failed a trial of conservative management and subsequently underwent a laparotomy and small bowel resection for small bowel obstruction. Histopathological analysis revealed diaphragm disease of the small bowel. This case emphasizes the complexities in the management of patients with incomplete small bowel obstruction and highlights the possibility of diaphragm disease of the bowel in the absence of known risk factors

Síndrome de Chilaiditi: relato de caso / Chilaiditi's syndrome: a case report

Os autores apresentam um caso de síndrome de Chilaiditi em uma mulher de 56 anos de idade. Mesmo tratando-se de condição benigna com rara indicação cirúrgica, reveste-se de grande importância pela implicação de urgência operatória que representa o diagnóstico equivocado de pneumoperitônio nesses pacientes. É realizada revisão da literatura, com ênfase na fisiopatologia, propedêutica e tratamento desta entidade.

The authors report a case of Chilaiditi's syndrome in a 56-year-old woman. Although this is a benign condition with rare surgical indication, it has great importance for implying surgical emergency in cases where such condition is equivocally diagnosed as pneumoperitoneum. A literature review is performed with emphasis on pathophysiology, diagnostic work-up and treatment of this entity.

Hernia diafragmática postraumática: reporte de un caso / Posttraumatic diaphragmatic hernia: report of a case

La hernia diafragmática traumática es poco frecuente en niños y aún continúa siendo una patología de difícil diagnóstico siendo un desafío para cirujanos y radiólogos, diagnosticándose tardíamente hasta en más de la mitad de los casos, dejando una hernia diafragmática latente, que puede manifestarse con síntomas que varían desde inespecíficos hasta la estrangulación de un asa intestinal. - Es considerada un indicador de gravedad del trauma y presenta una elevada tasa de morbilidad y mortalidad. - El objetivo de esta publicación es presentar un caso de hernia diafragmática secundario a un trauma toracoabdominal cerrado. Reportamos el caso de un niño de 4 años atropellado que presentó una hernia diafragmática derecha, Con una excelente evolución clínica...(AU)

Hérnia diafragmática congênita: revisão da literatura e relato de casos / Congenital diaphragmatic hernia: a literature review and case reports

A hérnia diafragmática congênita, tipicamente se apresenta na infância, no período neonatal imediato ou mais tardiamente em lactentes ou pré escolares, mas pode ser raramente detectada em adultos...Atualmente, com o advento de imagens digitais o diagnóstico precoce, até mesmo pré-natal, da hérnia diafragmática congênita tem contribuído para melhorar a morbidade e reduzir a mortalidade. O objetivo deste trabalho monográfico é fazer uma breve revisão bibliográfica sobre o tema em questão, revisando livros e artigos sobre o tema e descrevendo o mesmo de forma sucinta para então correlacioná-lo com os casos clínicos acompanhados no ambulatório de pediatria e pneumologia pediátrica do Hospital Universitário Antônio Pedro (HUAP).

Successful Vaginal Delivery of a Pregnant Woman with Cantrell's Pentalogy

Cantrell's Pentalogy is a rare condition that consists of defects involving the abdominal wall, lower sternum, anterior diaphragm, pericardium, and heart. In the literature to date, pregnant women with Cantrell's Pentalogy have not been discussed. We performed successful vaginal delivery of a 23-yr-old nulliparous, primigravid woman who had been diagnosed with this condition. Diagnosis was based on cardiac catheterization, angiography, and echocardiogram, and abdominopelvic CT. Vaginal delivery may be an option for women with Cantrell's Pentalogy and may be attempted with caution.

Congenital Hemidiaphragmatic Agenesis Presenting as Reversible Mesenteroaxial Gastric Volvulus and Diaphragmatic Hernia: A Case Report

A 70-yr-old woman complained of left sided chest pain and non-bilious vomiting for four days after taking a gastric bloating agent for an upper gastrointestinal study. The chest radiography revealed gastric air-fluid levels and bowel loops in the left thoracic cavity. An emergency thoracotomy was performed. The abdominal organs (stomach, spleen, splenic flexure of the colon) were in the left thorax and the entire left hemidiaphragm was absent. There were no diaphragmatic remnants visible for reconstruction of the left diaphragm. We provided warm saline irrigation and performed a left lower lobe adhesiotomy. Thirteen days after surgery, the chest radiography showed improvement in the herniation but mild haziness remained at the left lower lung field. Here we present the oldest case of congenital diaphragmatic agenesis presenting with transient gastric volvulus and diaphragmatic hernia.

Congenital Hemidiaphragmatic Agenesis Presenting as Reversible Mesenteroaxial Gastric Volvulus and Diaphragmatic Hernia: A Case Report

A 70-yr-old woman complained of left sided chest pain and non-bilious vomiting for four days after taking a gastric bloating agent for an upper gastrointestinal study. The chest radiography revealed gastric air-fluid levels and bowel loops in the left thoracic cavity. An emergency thoracotomy was performed. The abdominal organs (stomach, spleen, splenic flexure of the colon) were in the left thorax and the entire left hemidiaphragm was absent. There were no diaphragmatic remnants visible for reconstruction of the left diaphragm. We provided warm saline irrigation and performed a left lower lobe adhesiotomy. Thirteen days after surgery, the chest radiography showed improvement in the herniation but mild haziness remained at the left lower lung field. Here we present the oldest case of congenital diaphragmatic agenesis presenting with transient gastric volvulus and diaphragmatic hernia.

Prenatal MRI Findings of Fetuses with Congenital High Airway Obstruction Sequence

OBJECTIVE: To define the MRI findings of congenital high airway obstruction sequence (CHAOS) in a series of fetuses. MATERIALS AND METHODS: Prenatal fetal MR images were reviewed in seven fetuses with CHAOS at 21 to 27 weeks of gestation. The MRI findings were reviewed. The MRI parameters evaluated included the appearance of the lungs and diaphragm, presence or absence of hydrops, amount of amniotic fluid, airway appearance, predicted level of airway obstruction, and any additional findings or suspected genetic syndromes. RESULTS: All the fetuses viewed (7 of 7) demonstrated the following MRI findings: dilated airway below the level of obstruction, increased lung signal, markedly increased lung volumes with flattened or inverted hemidiaphragms, massive ascites, centrally positioned and compressed heart, as well as placentomegaly. Other frequent findings were anasarca (6 of 7) and polyhydramnios (3 of 7). MRI identified the level of obstruction as laryngeal in five cases and tracheal in two cases. In four of the patients, surgery or autopsy confirmed the MRI predicted level of obstruction. Associated abnormalities were found in 4 of 7 (genetic syndromes in 2). Postnatal radiography (n = 3) showed markedly hyperinflated lungs with inverted or flattened hemidiaphragms, strandy perihilar opacities, pneumothoraces and tracheotomy. Two fetuses were terminated and one fetus demised in utero. Four fetuses were delivered via ex utero intrapartum treatment procedure. CONCLUSION: MRI shows a consistent pattern of abnormalities in fetuses with CHAOS, accurately identifies the level of airway obstruction, and helps differentiate from other lung abnormalities such as bilateral congenital pulmonary airway malformation by demonstrating an abnormally dilated airway distal to the obstruction.

Malformações do diafragma e tubo digestivo: aspectos diagnósticos / Congenital anomalies of the diaphragm and digestive system: diagnostic aspects

As hérnias diafragmáticas estão associadas à elevada incidência de outras malformações, principalmente do sistema nervoso central e cardiovascular. As malformações do tubo digestivo, com exceção da atresia anal, estão frequentemente associadas ao polidrâmnio. O prognóstico está relacionado com a gravidade das malformações associadas, sendo elevada a taxa global de mortalidade quando estão presentes. O diagnóstico e a avaliação das malformações do diafragma e do tubo digestivo durante o período intra-uterino têm fundamental importância para a diminuição da morbimortalidade associada a esses casos, com consequente melhora da sobrevida. Objetiva-se com o presente estudo realizar uma atualização compreensiva, tecendo considerações gerais sobre as principais anomalias do diafragma e do tubo difestivo, correlacionando-as com aspectos relevantes de interesse clínico e prognóstico perinatal.

Casos quirúrgicos relevantes: agenesia del hemidiafragma izquierdo / Relevant surgical case: agenesis of the left hemidiaphragm

La agenesia diafragmática es una patología sumamente infrecuente en adultos, ya que usualmente son diagnosticadas en las primeras horas de vida, la cual se ve comprometida por las complicaciones que esta produce. Presentamos un caso de agenesia del hemidiafragma izquierdo, complicada por una perforación gástrica iatógénica, en un paciente de 16 años.

Pentalogía de Cantrell. A propósito de un caso / Pentalogy of Cantrell. A case report

Ectopia cordis is an extremely rare cardiac anomaly. The heart is localized partially or totally outside the thorax cavity. This anomaly occurs as an isolated defect or combined with others midline defects. Cantrell and colleagues described, in 1958, a syndrome including defects of the abdominal wall, sternum, diaphragm, pericardium and heart. There are few successful surgical cases with this pentalogy. We describe a case with this Cantrell's pentalogy. The cardiac malformation was a univentricular heart with pulmonary stenosis. The patient underwent successful surgical palliation with a systemic-to-pulmonary anastomosis and uneventful recovering.

Infected Infradiaphragmatic Retroperitoneal Extralobar Pulmonary Sequestration: A Case Report

Infradiaphragmatic extralobar pulmonary sequestration is an extremely rare congenital malformation. It is more frequently diagnosed in the antenatal period due to routine ultrasonic examination of the fetus or in the first 6 months of life, though on rare occasions it is discovered incidentally in adults. A 32-yr-old man presenting with epigastric discomfort and fever was referred. Computed tomographic scanning showed that a 16-cm, multiseptated, dumbbell-shaped, huge cystic tumor was located beneath the diaphragm. On the next day, 850 mL of thick yellowish pus was drained by sonography-guided fine needle aspiration for the purpose of infection control and diagnosis, but no microscopic organisms were found in repeated culture studies. Surgical removal of the cyst was performed through thoracoabdominal incision and most of these pathologic lesions were removed but we could not find the feeding arteries or any fistulous tract to surrounding structures. Histopathologic study revealed that it was extralobar pulmonary sequestration and culture study showed that many WBC and necrotic materials were found but there were no microorganisms in the cystic contents. We report the first case of an infected infradiaphragmatic retroperitoneal extralobar sequestration which was administered a staged management and achieved an excellent clinical course.

Hérnia diafragmática congênita simulando tumor de cólon em paciente adulto jovem / Congenital diaphragmatic hernia simulating a colon tumor in young adult patient

Os autores apresentam um caso de hérnia diafragmática congênita diagnosticada em paciente adulto jovem durante transoperatório de laparotomia exploradora. Esta, realizada visando a esclarecer quadro clínico sugestivo de obstrução colônica por etiologia neoplásica. É apresentada, ainda, uma revisão sobre o tópico, avaliando-se as semelhanças entre o caso em questão e as informações de literatura (AU)

The authors present a case of congenital diaphragmatic hernia diagnosed in a young adult patient during exploratory laparotomy. Surgery was performed to elucidate clinical findings sugestive of large bowel obstruction due to colonic neoplasia. It Is still presented a review about this subject, evaluating the similarities between the case and the literature informations (AU)

Drenagem anômala total das veias pulmonares: terapêutica cirúrgica dos tipos anatômicos infracardíaco e misto / Total anomalous pulmonary venous drainage: surgical therapy for the infradiaphragmatic and mixed anatomical types

OBJETIVO: Estudar a evolução hospitalar em portadores de drenagem anômala total de veias pulmonares (DATVP), nas formas infracardíaca e mista, submetidos a tratamento cirúrgico. MÉTODOS: De 65 pacientes operados com o diagnóstico isolado de DATVP, de dezembro/1993 a março/2002, foram selecionados, retrospectivamente, 7 (10,8 por cento) pacientes das formas mista e infradiafragmática, sendo 5 (71,4 por cento) do sexo masculino, idades variando de 5 dias a 19 (média de 7) meses, com diagnóstico clínico feito pelo ecocardiograma bidimensional. Quatro (57,1 por cento) pacientes apresentavam formas mistas, em um, obstrutiva intrínseca, com estenose discreta da veia inferior esquerda. Os restantes três (42,9 por cento) apresentavam a forma infradiafragmática obstrutiva, extrínseca ao nível do diafragma. Todas as operações foram realizadas através de esternotomia mediana, sob circulação extracorpórea hipotérmica com parada circulatória total em 2 casos. RESULTADOS: Obito hospitalar ocorreu em 1 paciente com DATVP infradiafragmática com conexão da veia vertical inferior com a veia porta. A causa mortis foi relacionada à falência de múltiplos órgãos e sistemas. O pós-operatório foi caracterizado pela presença de baixo débito cardíaco e hipertensão pulmonar em 4 (57,1 por cento) pacientes. CONCLUSAO: O resultado da correção cirúrgica desta anomalia está associado à morbidade e mortalidade aceitáveis, na dependência do encaminhamento e tratamento cirúrgico precoces, sem progressão do quadro de hipertensão vascular pulmonar.