A Clinical Observation of Congenital Diaphragmatic Hernia

Diaphragnatic hernia is one of the surgical emergencies of the childhood because of the life-threatening cardiorespiratory embarrassment frequently associated with it. This congenital condition is characterized by varying degrees of protrusion of the abdominal viscera into the thoracic cavity through an abnormal opening in the diaphragm this opening results from a defect in the complex embryologic developement of the diaphragm between the thoracic and abdominal cavities. We expenienced 16 cases of congenital diaphragmatic hernia which were diagnosed at Severance Hospital from May 1964 to April 1977, and obtained the following results. 1) In 16 cases, male were ten and female were six. They were eleven cases of bochdalek hernia, two cases of diaphragmntic eventration, one case of hiatal and two undetermined. 2) Onset of symptoms were within 24 hours in 7 cases and in the rest cases symptoms were occured up to 24 months. 3) Most common symptoms were dyspnea and cynosis. 4) Most common signs were decreased breathing sound on affected lung, PMI shifting, scaphoid abdomen and subcostal retraction. 5) Combined anomalies were band adhesion of intestinal loop, hypoplasia of left lung etc. 6) Small intestine were more frequently herniated as well as large intestine. 7) mortality rate between abdominal procedure and thoracic procedure was equal. 8) Cases whose symptoms were occured within 24 hours were 7, 5 of these 7 were expired, Expired cases were associated with marked respiratory difficulties and pulmonary hypoplasia.

Clinical Studies on Purpura

We observed clinically 150 cases who were admitted with complaing of purpura at the Pediatric Department of Severance Hospital Yonsei University College of Medicine during a period of 9 years from July, 1966 to June, 1975. In 150 cases, leukemia, 33 cases (22.0%), was most common disease, followed by I.T.P., allergic purpura, meningococcemia, aplastic a nemia, sepsis in order aqnd the incidence was 20.0% (30 cases), 19.3% (29 cases), 19.3% (29 cases), 14.0% (21 cases), 4.0% (6 cases) respectively. And we observed 1 case of thrombocytopenic purpura complicated with scarlet fever and primary hypersplenism respectively. The highest incidence was between the age of one and six years, and males were affected more frequently than females. Clinical manifestations were anemia, fever, abdominal pain, vomiting, joint pain in general symptoms and nasal bleeding, melena, gum bleeding in hemorrhagic symptoms. Major symptoms were fever, abdominal pain, anemia, na sal bleeding, melena, gum bleeding in thrombocytopenic purpura, and fever, abdominal pain, vomiting, meningeal irritation signs in non-thrombocytopenic purpura. I the laboratory findings, mean value of platelet count was below 40,000/mm(3) in thrombocytopenic purpura, but 190,000/mm(3) in non-thrombocytopenic purpura. And bleeding time was prolonged above 5 minutes in thrombocytopenic purpura, but was below 1 minute in non-thrombocytopenic purpura.