Is polysomnographic examination necessary for subjects with diaphragm pathologies?

OBJECTIVES: While respiratory distress is accepted as the only indication for diaphragmatic plication surgery, sleep disorders have been underestimated. In this study, we aimed to detect the sleep disorders that accompany diaphragm pathologies. Specifically, the association of obstructive sleep apnea syndrome with diaphragm eventration and diaphragm paralysis was evaluated. METHODS: This study was performed in Süreyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital between 2014-2016. All patients had symptoms of obstructive sleep apnea (snoring and/or cessation of breath during sleep and/or daytime sleepiness) and underwent diaphragmatic plication via video-assisted mini-thoracotomy. Additionally, all patients underwent pre- and postoperative full-night polysomnography. Pre- and postoperative clinical findings, polysomnography results, Epworth sleepiness scale scores and pulmonary function test results were compared. RESULTS: Twelve patients (7 males) with a mean age of 48 (range, 27-60) years and a mean body mass index of 25 (range, 20-30) kg/m2 were included in the study. Preoperative polysomnography showed obstructive sleep apnea syndrome in 9 of the 12 patients (75%), while 3 of the patients (25%) were regarded as normal. Postoperatively, patient complaints, apnea hypopnea indices, Epworth sleepiness scale scores and pulmonary function test results all demonstrated remarkable improvement. CONCLUSION: All patients suffering from diaphragm pathologies with symptoms should undergo polysomnography, and patients diagnosed with obstructive sleep apnea syndrome should be operated on. In this way, long-term comorbidities of sleep disorders may be prevented.

Eventração diafragmática / Diaphragmatic eventration

Os autores descrevem a ED, mostrando a sua classificação, as alterações fisiopatológicas que podem acarretar os meios diagnósticos e o seu tratamento (clínico algumas vezes, mas geralmente cirúrgico). Relatam suas experiências com 12 casos operados nos hospitais Getúlio Vargas e da Lagoa. Exceto em um caso, que veio com quadro de abdome agudo por volvo, todos apresentavam história de infecções respiratórias repetidas. Descrevem em seguida a técnica empregada nos 12 casos, ressaltando a sua preferência pelo acesso torácico e plo pregueamento do diafragma. Não houve complicações importantes no período pós-operatório

Agenesia de hemidiafragma derecho asociada a hipoplasia pulmonar bilateral, secuestro pulmonar extralobar con linfangiectasias y malformación adenomatoide congénita pulmonar: informe de un caso / Agenesis of the right hemidiaphragm associated with bilateral pulmonary hypoplasia, pulmonary sequestration, lymphangiectases and congenital pulmonary adenomatoid malformation: report of a case

La agenesia del hemodiafragma derecho es una anomalía extraordinariamente infrecuente. El caso que se presenta es apenas el tercero informado en la literatura y el primero asociado con hipoplasia pulmonar bilateral, secuestro pulmonar extralobar, linfangiectasias y adenomatosis congénita pulmonar tipo III de Stocker. El diagnóstico prenatal de malformación congénita del diafragma debe sospecharse en presencia de antecedentes maternos patológicos y/o de trastornos del embarazo. En este caso el embarazo y el parto fueron normales pero se encontró placenta "pequeña", cordón umbilical corto y oligohidramnios. Este último se ha asociado con hipoplasia pulmonar bilateral. La sobrevida informada en el total de los casos de agenesia de uno u otro hemodiafragma ha sido del 40 por ciento, en pacientes cuya función cardiopulmonar evolucionó hacia la normalidad después de la corrección quirúrgica. El diagnóstico prenatal en este caso no hubiese modificado el pronóstico porque la hipoplasia pulmonar bilateral es una patología incompatible con la vida