Assessment of balance performance and fear of falling in acromegalic patients: a comparative study.

BACKGROUND: Acromegaly may lead to balance disturbances and fear of falling due to changes in body composition and co-morbidities. AIM: The aim of this study was to evaluate balance and fear of falling in acromegalic patients and their relation with disease characteristics. MATERIALS AND METHODS: Forty-eight acromegalic patients and 41 age- and gender-matched controls were enrolled in the study. The median ages of the patients and controls were 48 (25-75) and 50 (25-67) yr, respectively. Berg Balance Scale (BBS) and one-leg stance test (OLST) were used to compare dynamic and static balance respectively, 50 meters walking test was used to compare functional capacity and falls efficacy scale-international (FES-I) was used to compare fear of falling between the groups. RESULTS: Balance tests (BBS and 50 meter walking test) and fear of falling (FES-I) were significantly disturbed in patients compared with controls. There was no significant difference in OLST. BBS and OLST were negatively and FES-I was positively correlated with age. FES-I was negatively correlated with BBS and OLST was positively correlated with 50 meters walking test. Only OLST was negatively correlated with disease duration. Logistic regression analysis revealed that balance was not affected by the presence of co-morbidities, postoperative vision loss and disease control. CONCLUSIONS: This is the first study showing that balance is disturbed in acromegalic patients. This disturbance is not related to disease control and co-morbidities but somewhat to disease duration.

Factors affecting the outcome in patients with gastroschisis: how important is immediate repair?

BACKGROUND: Since 30 years, we have attempted to repair gastroschisis as early as possible, often even in the delivery room. We examined 12 recent years of patient records to evaluate the effect of immediate repair and other factors on the outcome of gastroschisis. METHODS: We reviewed the medical records of patients presenting with gastroschisis (87) at the Children's Hospital of Michigan between 1998 and 2009. Data were evaluated specifically to determine the effect of the place of repair [obstetric hospital ("DR") vs. children's hospital ("OR")], the time of repair [less than an hour after delivery ("IR") or more than one hour ("ER")], and the type of repair [primary fascial repair and skin closure ("PR") vs. staged repair ("SR")]. RESULTS: Patients in the PR group were more likely to spend one week or less on MV (66% in PR vs. 11% in SR, p<0.01). Patients in the DR group were more likely to spend 2 weeks or less on TPN, as were patients in the PR group (51% in PR vs. 17% in SR, p<0.01). Patients in the PR group were more likely to stay in hospital for less than 3 weeks, but the IR and ER groups had almost same hospital stay. Major associated anomalies were present in 19 patients (29%). These patients and those with little or no peel tended to outperform those with peel in each of our outcome measures. CONCLUSION: Repair immediately after delivery is beneficial in terms of achieving primary closure of the defect, leading to shorter times on assisted ventilation and parenteral nutrition, and shorter hospital stays.

Sleep quality in fibromyalgia and rheumatoid arthritis: associations with pain, fatigue, depression, and disease activity.

OBJECTIVES: The aim of this study was to compare the sleep quality in patients with rheumatoid arthritis (RA) and fibromyalgia syndrome (FMS); and to evaluate the relationship between sleep quality and pain, fatigue, depression, and disease activity in patients with RA and FMS. METHODS: Forty RA, 40 FMS and 40 healthy controls were enrolled in the study. Disease activity and disease duration were reported in patients. Pain by visual analogue scale (VAS), fatigue by Multidimensional Assesment of Fatigue (MAF), depression by Beck Depression Index (BDI), and sleep quality by Pittsburgh Sleep Quality Index (PSQI) were gathered in all participants. RESULTS: All participants were aged between 20 and 65 years, with a mean age of 42.97±10.75 years. There was no significant difference with respect to demographic characteristics among the three study groups. Patients reported more depression than controls, but BDI scores were similar in FMS and RA patients. VAS pain scores and MAF scores were significantly different in the three groups (p<0.001). FMS and RA patients had poor sleep quality (p<0.001). FMS patients had daytime dysfunction due to sleep disorder and had worse habitual sleep efficiency than RA patients (p<0.05). In patients, positive correlations were found between PSQI and clinic assessment variables except disease duration. CONCLUSIONS: FMS and RA may have poor sleep quality when compared to subjects without rheumatologic disorders. The quality of sleep can be impaired by pain, fatigue, depression, and disease activity in such patients.

Does short-wave diathermy increase the effectiveness of isokinetic exercise on pain, function, knee muscle strength, quality of life, and depression in the patients with knee osteoarthritis? A randomized controlled clinical study.

BACKGROUND: Knee osteoarthritis (OA) is a painful condition causing disability and muscle weakness. Shortwave diathermy (SWD) is one of several physical therapy modalities and used predominantly as a pain reduction modality in the clinical practice. However, the efficacy of SWD in knee OA is still inconclusive. AIM: The aim of this study was to determine if SWD increase the effectiveness of isokinetic exercise on pain, function, muscle strength, quality of life and depression in patients with OA. DESIGN: This was a randomised, controlled clinical trial. SETTING: Inpatient Physiotherapy Department. POPULATION: Forty women aged between 42 and 74 years, with a diagnosis of bilateral primary knee OA. METHODS: Patients were sequentially randomized into two groups. Group 1 (N.=20) received SWD and isokinetic muscular strengthening exercises. Group 2 (N.=20) served as control group and they received isokinetic exercises only. Both of the programs were performed three days a week, for a duration of four weeks, and a total of 12 sessions. Patients were assessed before treatment (BT), after treatment (AT), and at a three-month follow-up (F). Outcome measures included visual analogue scale, Western Ontario and McMaster University Osteoarthritis Index, six minute walking distance, isokinetic muscle testing, Short Form 36 and Beck depression index. RESULTS: The patients with OA in each group had significant improvements in pain, disability, depression, walking distance, muscle strength, and quality of life AT and F when compared with their initial status (P<0.05). There was no statistically significant difference between the groups according to all the parameters regarding the change scores between AT-BT test and F-BT test (P>0.05) except some isokinetic peak torque measurements (F-BT scores of extension right 60°, 120° and flexion right 60°). CONCLUSION: Use of SWD in addition to isokinetic exercise program seems to have no further significant effect in terms of pain, disability, walking distance, muscle strength, quality of life and depression in patients with knee OA. CLINICAL REHABILITATION IMPACT: Considering the time and cost of combination therapy is now, the isokinetic exercise program, as it is efficient, may be preferable for the treatment of knee OA, alone.

Access to the hypertrophic pylorus: does it make a difference to the patient?

BACKGROUND: The aim of the study was to evaluate the effects of different access methods for the treatment of pyloric stenosis (PS). METHODS: Since 2001, we have operated on children with PS using three different access methods: classic right upper quadrant transverse incision (TI), incision on the superior umbilical fold (UI) and laparoscopic (L). We reviewed the records of these children with special emphasis on the number and characteristics of complications, operative time, and length of stay (LOS). RESULTS: We identified 256 patients (212 M, 44 F) with a mean age of 36 days. 138 procedures were performed using TI, 18 with UI and 100 laparoscopically. The mean operative time for patients with TI was 35.9 +/- 8.6 min, and for those with UI 31.8 +/- 9.3 min. Patients in the L group had a mean operative time of 29.8 +/- 11 min. Although the operative time for TI was significantly greater than that of L, the differences between the TI and UI groups and between UI and L groups did not reach statistical significance. For the TI, UI and L groups, the mean overall LOS was 3.22 +/- 0.3 days, 3.39 +/- 0.4 days and 2.94 +/- 0.2 days, and the mean postoperative LOS was 1.52 +/- 0.1 days, 1.44 +/- 0.2 days, and 1.56 +/- 0.1 days, respectively. No significant difference in LOS was found. One patient from each group had a wound infection. While three of four perforations occurred in the L group and the fourth was in the TI group, the difference in rates of perforation among the groups did not achieve statistical significance. The perforation during open surgery was typical, occurring on the duodenal end during spreading of the pyloric muscle. The perforations in the L group were atypical: one was a grasper injury to the duodenum; another was on the gastric end of the pyloric incision and the third occurred not during spreading of the pyloric muscle but during the cutting of it. The pylorus was relatively small in this particular case (12 mm in length). CONCLUSION: While the operative time of laparoscopic repair for PS is less than in either of the open approaches, laparoscopic surgery may increase the risk for atypical injuries to the bowel. Therefore, proper attention should be paid to dissection of the structures and the selection of laparoscopic instruments. Incision on the superior umbilical fold is a reasonable alternative access for the treatment of PS.

Long-term results of topical glyceryl trinitrate ointment in children with anal fissure.

BACKGROUND/AIM: Although topical glyceryl trinitrate ointment (GTN) has become a popular treatment for anal fissure in adults, its use in children is still limited. We aimed to determine the effectiveness and safety of topical GTN in the long-term management of anal fissure in children, which has not yet been reported. METHODS: Thirty-one children with anal fissure who received topical 0.2% GTN treatment between 1997 and 1998 were evaluated in 2004. RESULTS: Ten patients had one or more relapses after initial treatment with 0.2% GTN, all within 1 year of first onset of anal fissure. No further recurrences were diagnosed during the 4-year follow-up period. CONCLUSION: Although early recurrence can occur, topical GTN ointment is effective in healing chronic anal fissures in children.

High association of congenital heart disease with indirect inguinal hernia.

We evaluated 103 patients with indirect inguinal hernia (IIH) for the association of congenital heart disease by echocardiography. Congenital cardiac abnormalities were recognized in 32% of patients with inguinal hernia, which is significantly higher than that reported in a population-based study in Turkey and other population-based studies. Ventricular septal defect and valvular anomalies are the most frequently detected malformations. Our findings suggest that screening for congenital hearth disease is necessary in children with indirect inguinal hernia.

Local bleomycin injection in the treatment of lymphangioma.

AIM: We report here our experience with local bleomycin injection in lymphangioma. PATIENTS AND METHODS: Nine patients with lymphangioma were treated with locally injected bleomycin and followed prospectively. We performed an ultrasound study in all cases to delineate the size, location, nature, and number of compartments of the cyst prior to the injection. Under ultrasound guidance, the content of the cystic cavity was aspirated and 1 - 3 mg/kg bleomycin were injected. The patients were revisited monthly. No attempt at re-injection was made as long as the mass continued to decrease in size. RESULTS: Patients consisted of 4 boys and 5 girls aged between 14 days and 6 years. The localisation of the mass was cervical in 6, cervical, sublingual, and lingual in 1, axillary in 1 and axillary and thoracic in 1. In six children, the mass disappeared totally after a single injection. In one patient a second injection was needed, and surgical excision was performed in two patients with residual solid component. No complication related to bleomycin was seen. CONCLUSION: Local application of bleomycin in children with lymphangioma is a simple, safe, and effective method. In the majority of cases, total healing may be achieved with a single injection.

Anterior cervicothoracic meningocele treated by cystopleural shunt. Case report and review of the literature.

Anterior meningocele is a rare disease which is commonly observed in the sacral region. Anterio cervicothoracic meningocele is generally diagnosed in adult age and there are few reports in infancy. Different treatment procedures are performed such as ligation, resection and wrapping. The case of a 9-month-old male infant with acute respiratory distress and cyanosis is described. He had also recurrent lung infections for 3 months. The magnetic resonance imaging revealed an anterior cervicothoracic meningocele which was compressing the lung, aorta, esophagus and trachea associated with skeletal abnormalities and C2 - C7 syringohydromyelia. There was no evidence of neurofibromatosis. He was submitted to thoracotomy and treated with cystopleural shunt without valve system. Postoperatively his respiratory distress improved dramatically. Radiologically, the size of meningocele decreased and the syringomyelic cavity disappeared. There was no evidence of recurrence during his followup. Cystopleural shunt procedure is a reliable, simple and effective treatment modality in anterior cervicothoracic meningocele cases. This treatment regimen prevents possible neural damage and also treatments to the associated anomalies such as syringohydromyelia.

The utility of peritoneal drains in children with uncomplicated perforated appendicitis.

Peritoneal drainage in children with uncomplicated perforated appendicitis (UPA) is still controversial. Many pediatric surgeons prefer not to drain the peritoneal cavity in such cases. However, there is no randomized controlled study performed in children. We aimed to study the effects of peritoneal drainage in children with UPA in a randomized prospective trial. One hundred and forty consecutive patients with UPA were divided randomly into 2 groups. Group I (70 patients) consisted of cases with peritoneal drainage, and group II (70 patients) without drainage. UPA is defined as perforated appendicitis with no more discoloration of peritoneal fluid after peritoneal wash out. Cases with localized abscess in the peritoneum were excluded from the study. In all patients, the ages, duration of symptoms, nasogastric drainage and hospitalization, and complications after surgery were recorded. The duration of hospitalization and nasogastric draining time were significantly lower in patients without peritoneal drainage. There was no difference in postoperative complications between the two groups. The onset of oral intake after surgery was significantly earlier in group II patients. Placing drains in the peritoneum does not improve outcome in UPA. Therefore, we do not recommend routine drainage of children with UPA.

Congenital lobar emphysema: a clinicopathologic evaluation of 14 cases.

Controversy still exists concerning the diagnosis and treatment of congenital lobar emphysema (CLE). Although surgical removal of the affected lobe is the most commonly accepted form of treatment, detection of milder or even asymptomatic cases is usually followed by a more conservative management of patients, i. e. non-surgical treatment and follow-up. We therefore decided to evaluate our patients with CLE, placing special emphasis on treatment and diagnostic techniques. We also evaluated quantitative analyses of alveolar diameters. Fourteen children with CLE were analysed retrospectively, including age, sex, clinical picture, localisation, diagnostic and surgical modalities and histopathologic diagnosis. The alveolar diameters of affected lobes were compared with those of the lobectomised patients with other non-obstructive respiratory diseases. All children but one had severe respiratory distress as an initial symptom. All patients, except newborns, had a history of pulmonary infection. All cases underwent thoracic CT examination as the main radiologic method. In all of the patients, only one lobe was affected. We found an obvious mediastinal shift and atelectasis of adjacent lobes due to compression of the affected lobe. The affected lobe was therefore surgically removed in all of the children. In one case, we had to carry out a partial lobectomy to reduce the duration of the operation, due to an intraoperative fall of oxygen saturation. All of the children had an uneventful clinical course postoperatively. The alveolar diameters of the cases with CLE were significantly greater than those of the control patients. We think that the majority of cases with CLE have too severe respiratory distress to avoid surgical removal of affected lobe. Conservative management should be reserved only for patients with milder symptoms or no distress at all.

Effect of prenatal glucocorticoids and postnatal nitric oxide inhalation on survival of newborn rats with nitrofen-induced congenital diaphragmatic hernia.

BACKGROUND/PURPOSE: Pulmonary hypertension and pulmonary hypoplasia account for the high mortality rate associated with congenital diaphragmatic hernia (CDH). In animal models of CDH, postnatal nitric oxide (NO) inhalation resulted in significantly better survival rates and antenatal glucocorticoid administration in improved lung compliance. The objective of this study was to evaluate the combined effect of prenatal glucocorticoid administration and postnatal NO inhalation on the survival rate of newborn rats with nitrofen-induced CDH. METHODS: Right-sided CDH was induced by maternal administration of a single oral dose (100 mg, intraperitoneally) of nitrofen on day 11.5 of pregnancy. Dexamethasone (DEX, 0.25 mg/kg) was given in groups III and IV by maternal intraperitoneal injection on day 18.5 and 19.5 of pregnancy. Control animals (groups I and II) received vehicle alone. After spontaneous delivery, the newborn animals were exposed to either NO (80 ppm; groups II and IV) or room air (groups I and III). Vitality (Rat-Score), sO(2) and survival were monitored continuously for 12 hours until animals were killed. Hernia size was estimated as percentage of total thoracic content. RESULTS: Right-sided CDH was observed in 392 of 491 newborn rats (81%). Animals with large hernias (>50%) died within 4 hours after birth, irrespective of treatment. Hernias with less than 50% of the thoracic volume were considered clinically relevant hernias. In this category, 12.5% of animals without treatment (group I) survived compared with 63.6% after NO treatment alone (group II; P <.01). Survival rate after DEX treatment alone (group III) was 69.4% (group III v I; P <.01). In group IV (DEX and NO) 95.2% of the animals survived (group IV v I; P <.001). In contrast to DEX alone, NO administration resulted in significantly better sO(2)(group II and IV) compared with group I (P <.05). CONCLUSION: Combination of prenatal maternal glucocorticoids and postnatal NO inhalation significantly improved survival rate of newborn rats with nitrofen-induced CDH.

Ultrasonographic follow-up of infantile hypertrophic pyloric stenosis after pyloromyotomy: a controlled prospective study.

Although the ultrasonographic assessment of hypertrophic pyloric stenosis (IHPS) has become the main radiological method for this disease, our knowledge about postoperative ultrasonographic follow-up is very limited. To evaluate the ultrasonographic outcome of the pylorus, we performed ultrasonographic measurements of the pylorus in 22 children with IHPS, before and after the operation in a prospective trial. The sonograms following surgery were undertaken at the end of the 1st postoperative week and of the 1st, 3rd and 6th month postoperatively. Three main ultrasonographic parameters were used: pyloric muscle thickness (MT), pyloric diameter (PD) and pyloric length (PL). The values of the pylorus, especially the "MT" measurements, began to decrease almost by the end of the first postoperative week, and were normal by the 3rd month in the majority of cases. However, the averages of the PL and PD values never returned to normal throughout the 6 months follow-up. There was a highly significant difference between the average values of pyloric muscle thickness at admission and at the 6th month after surgery (p < 0.001). Within one month after surgery, the ultrasonographic parameters returned to the levels of those in control infants. However, except for MT, they did not return to their normal ranges. Therefore, MT is the most useful parameter for ultrasonographic postoperative evaluation if the normal ultrasonographic values, as given in the literature, are used.

The effects of chemical sympathectomy on testicular injury in varicocele.

OBJECTIVE: To determine whether the sympathetic nervous system plays a role in the contralateral testicular deterioration encountered in varicocele. MATERIALS AND METHODS: Forty male Sprague-Dawley albino rats (28 days old) were divided equally into four treatment groups, i.e. (1) sham operation, (2) with varicocele, (3) treated by chemical sympathectomy plus varicocele, and (4) chemical sympathectomy only. Chemical sympathectomy was induced by administering intraperitoneal 6-OH dopamine (100 microg/g for 5 days) in groups 3 and 4; groups 1 and 2 received equal volumes of physiological saline by the same route. All rats underwent laparotomy and part of the left renal vein (distal to the spermatic vein confluence) was isolated and encircled with a 4/0 silk suture. The suture was left untied in group 2, and tied around a 24 F peripheral venous cannula in groups 3 and 4. The testes were then excised when the rats were 70 days old; malondialdehyde (MDA) in the testicular tissue was assayed by the thiobarbituric acid-reactive substances method, and superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) levels were determined by spectrophotometric analysis. RESULTS: Varicocele resulted in a significant increase in MDA levels in both testes and chemical sympathectomy prevented this effect. SOD and GSH-Px values were significantly decreased in both testes in group 2; chemical sympathectomy also prevented this effect. CONCLUSION: An induced unilateral varicocele significantly increases the biochemical indicators of tissue hypoxia in both testes. As this increase was prevented by chemical sympathectomy, the sympathetic nervous system may play a role in the testicular degeneration associated with varicocele.

An unusual foreign body in the bowel lumen causing obstruction in a neonate.

Most of the foreign bodies swallowed by children pass the entire gastrointestinal tract without any complication. Neonatal intestinal foreign bodies are extremely rare. A newborn with a small bowel obstruction caused by a fresh grape is reported.

A case of incomplete Currarino triad with malignant transformation.

A case of an incomplete Currarino triad is reported. The baby underwent an emergency laparotomy due to a life-threatening intestinal obstruction caused by severe rectal stenosis. During the posterosagittal anorectoplasty (PSARP), a presacral teratoma was identified and resected. The tumor recurred three times; she initially responded to chemotherapy, but nonetheless died at the age of 4 years. In cases with evidence of anorectal stenosis, a presacral mass should be suspected. PSARP is the best choice of treatment for both the anorectal anomaly and excision of the presacral mass. The presacral region should be followed up closely for recurrence of the tumor.

A prospective, randomized, double-blind, placebo-controlled trial of glyceryl-trinitrate ointment in the treatment of children with anal fissure.

BACKGROUND: Anal fissure in children usually is treated by sitz baths, stool softeners, and analgesic ointments. However, some cases are intractable to the treatment. In recent years, it has been reported that nitric oxide donors such as local glyceryl-trinitrate (GTN) ointment causes a reversible chemical sphincterotomy. Although the GTN ointment can be an alternative therapy for adult cases, it has not yet been studied in the children who suffer from anal fissure. METHODS: Sixty-five children with anal fissure were divided randomly into 3 groups. Each group received double-blinded a topical ointment that contained either 0.2% GTN, 10% lidocaine, or placebo. These ointments were applied to the lowest part of the anal canal twice daily. Patients were periodically reviewed, and the study was ended after 8 weeks. RESULTS: Complete healing of the fissure occurred in 26 of 31 (83.9%) patients treated with GTN, 7 of 14 (50%) patients treated with lidocaine, and 6 of 17 (35.2%) treated with placebo. In 29 of 31 (93.5%) GTN-treated patients, a total relief of symptoms was observed, whereas this occurred in 7 of 14 (50%) treated with lidocaine and 6 of 11 (35.3%) in the placebo group. The differences between the study group and control groups were highly statistically significant (P < .001). CONCLUSION: The majority of children suffering from anal fissure will be cured and have relief of symptoms after topical application of GTN ointment to the anal canal.

Division of the genitofemoral nerve and late orchiectomy: effects on the contralateral testis in ipsilateral testicular torsion.

Unilateral torsion of the spermatic cord has been demonstrated to damage the contralateral testis; however, the pathogenesis has not yet been examined in detail. The purpose of this study was to evaluate the influence of unilateral torsion on the contralateral testis in rats by performing ipsilateral division of the genitofemoral nerve (GFN) and/or late orchiectomy. Male 25-day-old, prepubertal Wistar albino rats were divided into five groups: (1) sham operation; (2) unilateral testicular torsion; (3) simultaneous unilateral testicular torsion and ipsilateral GFN division; (4) unilateral testicular torsion and orchiectomy on the 4th day after torsion; and (5) simultaneous unilateral testicular torsion and GFN ipsilateral division, and orchiectomy on the 4th day after torsion. Torsions performed were 720 degrees, all on the right testes. On day 55 after torsion, which represents the early postpubertal period of the rat, the contralateral testes were removed. Tubular biopsy score (TBS) was calculated, and seminiferous tubular diameters (STD) were measured. Student's t-test was used for statistical analysis. There was no contralateral testicular damage in the control group, but in all of the study groups destructive changes were found in the left gonad after torsion of the right testicle. The mean TBS of the study groups was higher than that of the control group. STD values were lower in the study groups, but the differences were not statistically significant between groups. In prepubertal rats, unilateral torsion causes histologically measurable changes in the contralateral testis. Ipsilateral division of the GFN and late orchiectomy did not cause any significant alterations in terms of contralateral damage. Further investigations are needed to determine the role of the GFN in testicular torsion.

Inhaled nitric oxide increases survival rates in newborn rats with congenital diaphragmatic hernia.

The high mortality of newborn infants with congenital diaphragmatic hernia (CDH) can be partly attributed to pulmonary hypertension causing extrapulmonary right-to-left shunting with subsequent severe hypoxemia. Inhaled nitric oxide (NO) may reduce elevated pulmonary artery pressure and has been successfully improve arterial oxygenation in some newborns with CDH. However, it is not clear whether inhaled NO will actually improve survival of newborns with CDH. We therefore investigated the effect of inhaled NO on the survival rate of newborn rats with CDH following intrauterine exposure to nitrofen. A total of 151 newborn rats (9 litters) were exposed to nitrofen on day 11 of pregnancy, After spontaneous delivery, 63 newborn rats (4 litters) were allowed to spontaneously breathe air containing NO (80 parts per million), while 88 newborn rats (5 litters) were given air without NO. Survival was checked 15 min after birth and then hourly until the animals were sacrificed at 24 h of age to verify the absence or presence of CDH. The 2 groups of newborn rats breathing air with or without NO did not differ significantly with respect to the presence or size of CDH. Twenty-four of 63 (38%) newborn rats breathing air with NO survived for 24 h, compared to 12 of 88 (14%) rats breathing air alone (p < 0.01). Of newborn rats that were actually found to have CDH (n = 113), 8 of 42 (19%) animals breathing air with NO survived for 24 h, compared to 2 of 71 (2.8%) animals breathing air alone (p < 0.01). In animals with CDH confirmed by autopsy, the median survival time was significantly longer with NO (p < 0.001) ( 2 h, interquartile range 2h-15h), than those breathing or without NO (median/interquartile range 15 min). We conclude that in the nitrofen rat CDH model, significantly improved survival rates occur with inhaled NO as a sole intervention. The combined impact of inhaled NO and mechanical ventilation remains to be determined.