ABSTRACT
A case of right-sided diaphragmatic rupture due to blunt trauma is reported. The diagnosis was confirmed by sonography and diagnostic pneumoperitoneum. Ultrasonography was of great value by showing a discontinuous, 'flapping' ruptured diaphragm. Computed tomography was of no value. It was concluded that when right-sided diaphragmatic rupture is suggested sonographic examination should be performed. If the sonographic examination is non-diagnostic, a pneumoperitoneum should follow.
Subject(s)
Diaphragm/injuries , Humans , Male , Middle Aged , Pneumoperitoneum, Artificial , Rupture , Tomography, X-Ray Computed , Ultrasonography , Wounds, Nonpenetrating/diagnosis , Wounds, Nonpenetrating/diagnostic imagingABSTRACT
Oesophageal tissue reaction to different suture materials (chromic catgut, silk, prolene and stainless steel wire) was analysed and compared in 45 cats with and without reflux oesophagitis. Diffuse reflux oesophagitis was produced in 12 out of 21 animals subjected to oesophagocardiomyotomy (Marwedel-Wendel) combined with production of a fixed hiatal hernia of sliding type. Steel wire sutures produced minimal tissue reaction and undisturbed fibroplasia both in the intact oesophagus and in the presence of reflux oesophagitis. The steel wire sutures were found to be superior to the chromic catgut, silk, and prolene.
Subject(s)
Esophagitis, Peptic/chemically induced , Esophagus/drug effects , Sutures/standards , Wound Healing/drug effects , Animals , Catgut , Cats , Chromium/adverse effects , Esophagoplasty , Esophagus/pathology , Granulation Tissue/drug effects , Granulation Tissue/pathology , Mucous Membrane/pathology , Polypropylenes/adverse effects , Stainless Steel/adverse effects , Tensile Strength , Time FactorsSubject(s)
Diaphragm/physiopathology , Lung/physiopathology , Paralysis/physiopathology , Blood Gas Analysis , Forced Expiratory Volume , Hernia, Diaphragmatic/surgery , Humans , Maximal Voluntary Ventilation , Postoperative Complications , Posture , Respiratory Function Tests , Spirometry , Thoracic Injuries/complications , Vital Capacity , Xenon RadioisotopesABSTRACT
64 subjects with hiatus hernia (34 sliding, 22 mixed, and 8 of paraesophageal variety) were divided into 3 groups according to the transverse diameter of the thoracic loculus and examined by 133Xe-radio-spirometry in the supine position. 48 subjects (22 sliding, 18 mixed, and 8 or paraesophageal variety) showed a significant reduction in the regional ventilation, perfusion or lung volume. Significant correlations were found between the diameter of the thoracic loculus and the reduction in these vairables of the affected lung.
Subject(s)
Hernia, Diaphragmatic/physiopathology , Hernia, Hiatal/physiopathology , Respiration , Adult , Aged , Female , Humans , Male , Middle Aged , Pulmonary Circulation , Pulmonary Ventilation , Regional Blood Flow , SpirometryABSTRACT
As a part of a preoperative investigation, spirometry and blood gas tensions were studied in 64 subjects with X-ray-verified hiatus hernia (34 sliding, 22 mixed, and 8 of paraesophageal variety). According to the transverse diameter of the hernia. They were divided into 3 groups, small (2-5.9 cm), medium (6-9.9 cm), and large (10-17 cm) hernias. No correlation between the size of the hernia, reflux incidence, and spirometric findings could be demonstrated. A significant reduction of the arterial oxygen tension was found in small hernias and in vital capacity and maximal voluntary ventilation (MVV) in medium-sized hernias. Significant reduction in MVV was noted in the large hernia group. A common spirometric finding in all groups was a significant increase in residual volume and wash-out volume. The incidence of restrictive or obstructive pulmonary impairment was high in large (39%) and small (32%) hernias and relatively low in medium-sized hernias (8%). Roentgenological fibrosis was not found in any of the patients, while 4 showed emphysematous changes.
Subject(s)
Hernia, Diaphragmatic/physiopathology , Hernia, Hiatal/physiopathology , Respiration , Adult , Aged , Carbon Dioxide/blood , Female , Gastroesophageal Reflux/etiology , Hernia, Hiatal/complications , Hernia, Hiatal/diagnostic imaging , Humans , Lung Diseases, Obstructive/etiology , Male , Middle Aged , Oxygen/blood , Partial Pressure , Radiography , Spirometry , Vital CapacityABSTRACT
Global and regional lung function were studied in 17 subjects with hemidiaphragmatic paralysis. Global lung function (VC, MVV, and FEV1) in the sitting postion was reduced by an average of about 25%. Regional lung function data in the same position showed a considerable decrease in perfusion (19%), ventilation (20%), and lung volume (7%) of the diseased side as compared to reference values obtained in healthy volunteers. Compared to the partition of function in the supine, the perfusion of the affected lung increased when it was lowermost in the lateral decubitus postion, while regional FRC decreased and ventilation changed little. When uppermost, perfusion and ventilation of the affected lung decreased while FRCr increased somewhat. The arterial oxygen tension was significantly below normal in the supine position but in the normal range in the sitting position. It increased further during exercise. Bronchography showed compression of the basal lung segments on the affected side in the erect, and kinking and obliteration of lower lobe bronchi in the supine position and still more when the lung was lowermost in the lateral decubitus position.
