RESUMO
Congenital diaphragmatic hernia (CDH) is a congenital anomaly associated with an increased mortality and morbidity. In this article, we review the currently known etiological and pathogenic factors in CDH.
Assuntos
Hérnias Diafragmáticas Congênitas , Diafragma/embriologia , Regulação da Expressão Gênica no Desenvolvimento , Hérnia Diafragmática/etiologia , Hérnia Diafragmática/fisiopatologia , Humanos , Pulmão/irrigação sanguínea , Pulmão/embriologia , Transdução de Sinais , Tretinoína/metabolismoRESUMO
The primary therapeutic target for congenital diaphragmatic hernia (CDH) patients has shifted from emergency surgical repair towards a non-operative emergency of the newborn treated by interdisciplinary teams. The increased understanding of the epidemiological and pathophysiological aspects of CDH have led to an improved knowledge and application of prenatal diagnosis, postnatal ventilation strategies, treatment of associated pulmonary hypertension and the role of extracorporeal membrane oxygenation therapy. In the surgical field, the perspectives have changed with delayed CDH repair, the introduction of minimally invasive surgery and use of prosthetic material for closure of large defects. With decreased mortality, long term multi-organ morbidity has increased in some survivors. In the near future, randomized controlled trials on different aspects of therapy will determine evidence-based optimal care.
Assuntos
Hérnia Diafragmática/cirurgia , Hérnias Diafragmáticas Congênitas , Oxigenação por Membrana Extracorpórea , Feminino , Hérnia Diafragmática/fisiopatologia , Hérnia Diafragmática/terapia , Humanos , Hipertensão Pulmonar/tratamento farmacológico , Hipertensão Pulmonar/etiologia , Recém-Nascido , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos , Gravidez , Diagnóstico Pré-Natal , Resultado do Tratamento , Vasoconstritores/uso terapêuticoRESUMO
This review gives an overview of the disease spectrum of congenital diaphragmatic hernia (CDH). Etiological factors, prenatal predictors of survival, new treatment strategies and long-term morbidity are described. Early recognition of problems and improvement of treatment strategies in CDH patients may increase survival and prevent secondary morbidity. Multidisciplinary healthcare is necessary to improve healthcare for CDH patients. Absence of international therapy guidelines, lack of evidence of many therapeutic modalities and the relative low number of CDH patients calls for cooperation between centers with an expertise in the treatment of CDH patients. The international CDH Euro-Consortium is an example of such a collaborative network, which enhances exchange of knowledge, future research and development of treatment protocols.
Assuntos
Hérnia Diafragmática/complicações , Hérnias Diafragmáticas Congênitas , Animais , Cuidados Críticos , Oxigenação por Membrana Extracorpórea , Feminino , Refluxo Gastroesofágico/etiologia , Refluxo Gastroesofágico/terapia , Perda Auditiva Neurossensorial/etiologia , Hérnia Diafragmática/etiologia , Ventilação de Alta Frequência , Humanos , Hipóxia Encefálica/etiologia , Recém-Nascido , Obstrução Intestinal/etiologia , Obstrução Intestinal/terapia , Transtornos da Linguagem/etiologia , Pneumopatias/etiologia , Pneumopatias/terapia , Transtornos das Habilidades Motoras/etiologia , Gravidez , Cuidado Pré-Natal , Infecções Respiratórias/etiologiaRESUMO
In antiquity the 'higher' study of medicine shared with many other disciplines a pronounced philological character. Galen both exploited this 'philological paradigm' and underwent its influence. He exploited it in that it enabled him to invest the Corpus Hippocraticum with a dignity comparable to that of Homer only. But his philological instrumentarium, originally designed for the study of literary texts, also forced him to pose and answer certain questions that shed no light whatsoever on the informational content of Hippocrates' writings, questions about Hippocrates' language and style. Galen disentangles himself from the ensuing embarrassment by claiming that Hippocrates' style was ideal for the specific didactic genre he was involved in. This special style necessitates a reassessment of customary grammatical and rhetorical values: correctness recedes into the background, clarity and brevity become the predominant virtues of style.
