High-frequency oscillatory ventilation versus conventional mechanical ventilation in congenital diaphragmatic hernia.

AIMS: Newborns affected by congenital diaphragmatic hernia (CDH) are high-risk patients: today the mortality is still elevated and is essentially due to severe pulmonary hypoplasia, pulmonary hypertension and the absence of surfactant. High-Frequency Oscillatory Ventilation (HFOV) seems to be a good pre- and postoperative technique in cases of CDH. PATIENTS AND METHODS: We report our experience in the treatment of CDH; since 1987 we have followed 44 patients. We divided them into two different groups in accordance with the ventilation technique used: Group I (1987-1994): 25 patients treated with conventional mechanical ventilation (CMV); Group II (1994-1997): 19 patients treated with HFOV used since the first day of life until clinical stabilisation and also prolonged during surgery and in the postoperative period. RESULTS: 37 patients (84%) underwent surgery with closure of the diaphragmatic defect. We had a very good improvement in survival, rising from 67% (CMV) to 94% (HFOV) of the patients operated on, reaching an overall survival of 56% vs 79%. CONCLUSIONS: The use of HFOV for the treatment of CDH has proved to be a valuable technique for pre-operative stabilisation and for intra- and postoperative respiratory treatment, above all for newborns with CDH.

A case of non-functioning antiperistaltic retrosternal colic conduit replaced in situ and substituted with an isoperistaltic segment of ileum-caecum.

The authors report the case of a female patient, affected by long-gap oesophageal atresia, who, at 5 months old, was operated on for retrosternal substitution with a right-transverse antiperistaltic colic segment, in her local district hospital. Due to the anomalous position the neooesophagus never worked, and the baby was seriously dysphagic and failed to thrive. For this reason, when she was 11 months old, she was reoperated in our department. Through a medium sternolaparotomy the antiperistaltic colon was removed and replaced between the left and right colon; reconstruction was carried out with a retrosternal and isoperistaltic segment of ileo-caecum. The reoperation resolved her problems. This case is reported to confirm the author's opinion that all intestinal conduits must be positioned in the isoperistaltic direction.

Reduced neutrophil superoxide generation and plasma lipoperoxide levels in pigs fed with cod liver oil.

Circulating neutrophils, isolated from pigs fed for 8 weeks with a diet supplemented with CLO, had an accentuated n-3 fatty acid incorporation into the plasma membrane, as evidenced by an approximately four-fold greater n-3/n-6 ratio as compared with the control diet group. Moreover, the neutrophils of the CLO fed pigs produced less superoxide when stimulated with PMA or f-MLP, as well as showing a more prolonged latency period before O2(-)-generation. In the plasma of pigs fed with CLO there were higher levels of thiobarbituric reactive material and lipofuscin, while the content of GSSG was similar in both dietary groups. The results of this study indicate that dietary supplementation with CLO reduces the activation of circulating neutrophils and favours the presence in the plasma of lipoperoxides.

Prevention of platelet aggregation by dietary polyunsaturated fatty acids in the biodegradable polyurethane vascular prosthesis: an experimental model in pigs.

A 6-7 cm long degradable polyurethane vascular prosthesis was implanted in the infrarenal aorta of 25 young growing pigs, sacrificed from day 30 to 365 to study the processes of degradation and tissue growth, the characteristics of prosthetic substitutes and the incidence of thrombosis. Ten animals were used as controls and 15 were fed with cod liver oil (25 ml twice daily). Aortography performed at day 30, 60 and 90 showed 100% thrombosed implants in the controls, while in the lipid diet fed animals there was 100% patency. At graft retrieval, there were 7 patent grafts out of 9 in the cod liver oil fed animals. Laboratory tests indicated that the lipid diet rich in n-3 polyunsaturated fatty acids induces significant modifications of lipid metabolism preventing platelet aggregation. These data correlate well with findings of the morphological studies showing that all patent prostheses are lined with tissues similar to the endothelium of the native aorta with a mid layer made of circular and longitudinal smooth muscle cells well differentiated at day 180. These data show that the essential polyunsaturated fatty acid rich diet is able to prevent thrombosis of the biodegradable polyurethane vascular prosthesis. The combination of a synthetic material and the lipid diet experimental model, makes it possible to assess the long-term tissue-synthetic material interaction and the process of tissue growth.