Herniation Of Abdominal Organs Research Articles

MicroRNAs in congenital diaphragmatic hernia: insights into prenatal and perinatal biomarkers and altered molecular pathways

BackgroundCongenital diaphragmatic hernia (CDH) is characterized by a diaphragmatic defect, leading to herniation of abdominal organs into the chest, lung compression, and impaired lung development, often resulting in pulmonary hypertension and lung hypoplasia. Prenatal imaging techniques like ultrasound and MRI provide anatomical predictors of outcomes, but their limitations necessitate novel biomarkers for better prognostic accuracy. ObjectiveThis study aims to identify unique circulating maternal, fetal, and neonatal microRNAs (miRNAs) that can distinguish CDH pregnancies from healthy controls and assess their potential as markers of disease severity. Study DesignWe conducted a prospective study involving third-trimester maternal blood, amniotic fluid, cord blood, and neonatal blood samples from pregnancies complicated by CDH and healthy controls. miRNA expression was analyzed using RNA-sequencing, and random forest analysis identified miRNAs distinguishing CDH survivors from nonsurvivors. Pathway enrichment analyses were performed to explore the biological relevance of differentially expressed miRNAs. ResultsSignificant miRNA expression differences were observed between CDH and control samples across all sample types. In infant blood, 148 miRNAs were up-regulated, and 36 were down-regulated in CDH cases. Pathway analysis revealed that dysregulated miRNAs in CDH targeted pathways related to protein binding, transcription regulation, and signaling pathways implicated in pulmonary hypertension and lung hypoplasia. Random forest analysis identified miRNAs in maternal blood (miR-7850-5p_L-1R+2, miR-942-3p, and miR-197-3p) that distinguished CDH survivors from nonsurvivors, with an receiver operating characteristic area under the curve of 1.0. ConclusionCirculating miRNAs in maternal blood offer promising biomarkers for predicting CDH outcomes. miRNAs from infant blood provide mechanistic insights and potential targets for therapeutic intervention in critical pathways of pulmonary hypertension and lung hypoplasia. Further studies with larger cohorts are needed to validate these findings and explore the clinical application of miRNA biomarkers in CDH management.

030. Delayed Presentation of Blunt Traumatic Diaphragmatic Hernia 15 Years After Injury: A Case Report

Background: Traumatic diaphragmatic rupture is rare with incidence between 0.8-8% and often resulting from blunt or penetrating trauma. We present a case of delayed diaphragmatic hernia in a 41-year-old male, 15 years after blunt abdominal trauma. Case: A 41-year-old male presented with dyspnea and severe abdominal pain. He reported being struck in the abdomen with wood during a gang attack 15 years prior. A year after the accident, he complained of uncomfortable breathing that worsened in the past 6 years. Physical examination revealed decreased breath sounds on the left side and a distended abdomen. Imaging confirmed bowel herniation into the left hemithorax, partial lung collapse, and a mediastinal shift. Emergency laparotomy revealed a 5 cm diaphragmatic defect, massive gastric necrosis, and herniation of abdominal organs into the thoracic cavity. The defect was closed with primary repair, and necrotic gastric tissue was excised and repaired using primary closure with omental patch. The patient recovered well and was discharged on day 11. Conclusion: Diaphragmatic ruptures require prompt surgical repair to prevent complications. Physicians must carefully evaluate trauma history and conduct thorough examinations to improve outcomes in emergency settings.

The brain of fetuses with congenital diaphragmatic hernia shows signs of hypoxic injury with loss of progenitor cells, neurons, and oligodendrocytes

Congenital diaphragmatic hernia (CDH) is a birth defect characterized by incomplete closure of the diaphragm, herniation of abdominal organs into the chest, and compression of the lungs and the heart. Besides complications related to pulmonary hypoplasia, 1 in 4 survivors develop neurodevelopmental impairment, whose etiology remains unclear. Using a fetal rat model of CDH, we demonstrated that the compression exerted by herniated organs on the mediastinal structures results in decreased brain perfusion on ultrafast ultrasound, cerebral hypoxia with compensatory angiogenesis, mature neuron and oligodendrocyte loss, and activated microglia. In CDH fetuses, apoptosis was prominent in the subventricular and subgranular zones, areas that are key for neurogenesis. We validated these findings in the autopsy samples of four human fetuses with CDH compared to age- and sex-matched controls. This study reveals the molecular mechanisms and cellular changes that occur in the brain of fetuses with CDH and creates opportunities for therapeutic targets.

Open Versus Thoracoscopic Repair of Congenital Diaphragmatic Hernia: A 19-Year Review in a Tertiary Referral Centre in Hong Kong

BackgroundCongenital diaphragmatic hernia (CDH) is a developmental defect that causes herniation of abdominal organs into the thoracic cavity with significant morbidity. Thoracoscopic repair of CDH is an increasingly prevalent yet controversial surgical technique, with limited long-term outcome data in the Asian region. The aim of this study was to compare open laparotomy versus thoracoscopic repair of CDH in paediatric patients in a major tertiary referral centre in Asia. MethodsWe performed a retrospective analysis of neonatal patients who had open laparotomy or thoracoscopic repair for CDH in our institution between July 2002 and November 2021. Demographic data, perioperative parameters, recurrence rates and surgical complications were analysed. Results64 patients were identified, with 54 left sided CDH cases. 33 patients had a prenatal diagnosis and 35 patients received minimally invasive surgical repair. There was no significant difference between open and minimally invasive repair in recurrence rate (13 % vs 17 %, P = 0.713), time to recurrence (184 ± 449 days vs 81 ± 383 days, P = 0.502), or median length of ICU stay (11 ± 14 days vs 13 ± 15 days, P = 0.343), respectively. Gastrointestinal complications occurred in 7 % of neonates in the open group and none in the thoracoscopic group. Median follow-up time was 9.5 years. ConclusionsThis study is a large congenital diaphragmatic hernia series in Asia, with long term follow-up demonstrating no significant difference in recurrence rate, time to recurrence or median length of ICU stay between open and minimally invasive repair, suggesting thoracoscopic approach is a non-inferior surgical option with avoidance of gastrointestinal complications compared to open repair. Level of Evidence3. Type of StudyRetrospective Cohort Study.

The Association between the First Cry and Clinical Outcomes in CDH Neonates: A Retrospective Study.

Congenital diaphragmatic hernia (CDH) is a life-threatening condition characterized by the herniation of abdominal organs into the thorax, resulting in hypoplastic lungs and pulmonary hypertension. The impact of the first cry, a crucial event for lung transition during birth, on CDH patients remains unclear. This study investigated the impact of the first cry during birth on CDH patient survival, along with other prognosis factors. A multi-institutional retrospective study assessed CDH patient characteristics and survival rates by analyzing factors including the first cry, disease severity, birth weight, Apgar scores, oxygenation index (OI) and surgical closure. Among the CDH patients in the study, a positive first cry was linked to 100% survival, regardless of disease severity (p < 0.001). Notably, the presence of a positive first cry did not significantly affect survival rates in patients with worse prognostic factors, such as low birth weight (<2500 g), high CDH severity, low Apgar scores (1 min ≤ 4), high best OI within 24 h after birth (≥8), or those who underwent patch closure. Furthermore, no significant association was found between the first cry and the use of inhaled nitric oxide (iNO) or extracorporeal membrane oxygenation (ECMO). In conclusion, this study suggests that the first cry may not have a negative impact on the prognosis of CDH patients and could potentially have a positive effect.

Traumatic Diaphragmatic Rupture with Transthoracic Herniation of Abdominal Organs: A Case Series and Our Experience

Traumatic Diaphragmatic Rupture with Transthoracic Herniation of Abdominal Organs: A Case Series and Our Experience

Beyond the diaphragm and the lung: a multisystem approach to understanding congenital diaphragmatic hernia.

Congenital diaphragmatic hernia (CDH) is a birth defect characterized by the incomplete closure of the diaphragm and herniation of abdominal organs into the chest during gestation. This invariably leads to an impairment in fetal lung development (pulmonary hypoplasia) that involves the pulmonary vessels (vascular remodeling) leading to postnatal pulmonary hypertension. Moreover, approximately 60% of CDH survivors have long-term comorbidities, including critical cardiac anomalies, neurodevelopmental impairment, gastroesophageal reflux, and musculoskeletal malformations. While the pathophysiology of the diaphragmatic defect and pulmonary hypoplasia have been studied in detail over the decades, less is known about the other organs affected in CDH. In this review, we searched the literature for reports on other organs beyond the lung and diaphragm in human and experimental models of CDH. We found studies reporting gross morphometric changes and alterations to biological pathways in the heart, brain, liver, kidney, gastrointestinal tract, and musculoskeletal system. Given the paucity of literature and the importance that these comorbidities play in the life of patients with CDH, further studies are needed to comprehensively uncover the pathophysiology of the changes observed in these other organs.

X-ray Chest in Congenital Diaphragmatic Hernia: A Case Report

Congenital diaphragmatic hernia (CDH) is characterized by the presence of pulmonary hypoplasia or agenesis involving the left, right or both lungs, the failure of diaphragmatic closure, and the herniation of abdominal organs into the thoracic cavity. The incidence of diaphragmatic hernia ranges from approximately 0.8-5/10,000 births and varies across populations. The signs and symptoms including respiratory distress and bowel sounds in the chest cavity, no breathing sounds in one of the hemithorax and shifting of heart sounds. Chest X-ray is simple yet mostly available modality to confirm the diagnosis.

Traumatic diaphragm rupture treated with left anterolateral thoracotomy approach: a case report

Background: Traumatic diaphragmatic rupture (TDR) is a life-threatening condition due to the herniation of abdominal organs into pleural cavities. Rupture can occur in patients with major blunt or penetration trauma of the lower chest. Blunt TDR is usually caused by momentary high energy damage and is associated with severe trauma. This study aims to evaluate our hospital's experience with managing patients with blunt TDR, including its incidence, modes of diagnosis, operative treatments, postoperative outcomes, and factors predictive of patient outcomes. Case Report: A 44 years old man was referred to our hospital complaining of dyspnea. Eleven hours before his admission, he was riding his motorcycle, fell to the road, and hit the tree on his left chest. After the accident, he feels dyspnea, chest pain, and abdominal pain. The patient was brought to the nearest hospital and underwent a chest x-ray and left chest tube insertion, with initial production was blood 1700 ml. On examination, there was an increased respiratory rate, a visible bruise of the posteroinferior left chest near the left flank and a pre-installed chest tube thoracostomy on the left chest. Chest x-ray showed an intrathoracic herniation of abdominal viscera, the "collar sign" appeared, and the abdomen x-ray showed the left upper quadrant abdominal organ displaced into the left thorax cavity. Thus suspected, the underlying condition of TDR in this patient. We decided to perform left anterolateral thoracotomy and continued with laparotomy and splenectomy Conclusion: TDR is a rare case. The trauma may include shearing a stretched diaphragm, avulsion from a muscular insertion point, or increased abdominal pressure exceeding the bursting pressure of the diaphragm. Intra-abdominal organ injuries are more common than intrathoracic injuries. Initial operative approaches were laparotomy and thoracotomy.

Maternal cigarette smoking and alcohol consumption and congenital diaphragmatic hernia.

BackgroundCongenital diaphragmatic hernia (CDH) occurs when abnormal diaphragm development allows herniation of abdominal organs into the thoracic cavity. Its etiopathogenesis is not well understood, but cigarette smoking and alcohol exposure may impact diaphragm development. Using data from a large, population‐based case–control study, we examined associations between maternal cigarette smoking and alcohol consumption and CDH in offspring.MethodsWe analyzed maternal interview reports of cigarette smoking and alcohol consumption during early pregnancy for 831 children with CDH and 11,416 children without birth defects with estimated dates of delivery during 1997–2011. Generalized linear mixed effects models with a random intercept for study site were used to estimate associations between measures of exposure to smoking (any, type, frequency, duration) and alcohol (any, quantity, frequency, variability, type) for all CDH combined and selected subtypes (Bochdalek and Morgagni).ResultsMothers of 280 (34.0%) case and 3,451 (30.3%) control children reported early pregnancy exposure to cigarette smoking. Adjusted odds ratios for all CDH were increased for any (1.3; 95% confidence interval 1.1–1.5), active (1.3, 1.0–1.7), and passive (1.4, 1.1–1.7) smoking. Early pregnancy alcohol consumption was reported by mothers of 286 (34.9%) case and 4,200 (37.0%) control children; odds were near the null for any consumption (0.9, 0.8–1.1) and consumption with (0.9, 0.7, 1.1) or without (0.9, 0.8, 1.1) binging. Estimates for smoking and alcohol tended to be higher for Bochdalek CDH and Morgagni CDH than those for all CDH.ConclusionsFindings suggest that maternal early pregnancy exposure to cigarette smoking, but less so to alcohol consumption, contributes to CDH. These findings need to be replicated in additional large studies that use systematic case ascertainment and classification, detailed exposure assessment, and examine subtype‐specific associations.

260 Antepartum and delivery outcomes for growth-restricted fetuses based on gastroschisis-specific fetal growth curves

To determine the utility of gastroschisis-specific fetal growth curves by evaluating antepartum and delivery outcomes for fetuses with fetal growth restriction (FGR) based on Hadlock growth curves compared to gastroschisis-specific growth curves. This was a single-institution, retrospective cohort study of pregnancies complicated by isolated gastroschisis delivered between 2011 and 2020. Using ultrasound biometric data, we generated estimated fetal weight growth curves specific to fetuses with gastroschisis, including the 10th, 50th, and 90th percentiles between 15 and 37 weeks. We compared antepartum and delivery outcomes for fetuses diagnosed with FGR by Hadlock growth curves to fetuses diagnosed with FGR by gastroschisis growth curves. 413 ultrasounds from 116 fetuses were included. 67 (58%) of the fetuses met criteria for FGR based on Hadlock growth curves, and 28 (24%) met criteria based on the gastroschisis growth curves. 60% of fetuses diagnosed with FGR by Hadlock were misdiagnosed based on the new growth curves. When comparing fetuses with FGR by Hadlock to those with FGR by the gastroschisis curves, the new curves better predicted 5 out of 16 observed outcomes, including: increased betamethasone administration (52% vs 45%, p=0.001), decreased spontaneous vaginal delivery (43% vs 51%, p<0.001), increased cesarean delivery (54% vs 49%, p=0.001), increased unplanned hospital admission (96% vs 82%, p<0.001), and worsening bowel findings leading to delivery (39% vs 28%, p=0.033). Hadlock growth curves derived from non-anomalous fetuses over-diagnose FGR in fetuses with gastroschisis due to small abdominal circumference measurements caused by abdominal organ herniation. FGR defined by gastroschisis-specific growth curves better predicts many of the common perinatal outcomes seen in pregnancies complicated by this anomaly. Given the known risks of prematurity, using gastroschisis-specific growth curves may assist in improved risk stratification and delivery planning among cases of gastroschisis.

120 Hadlock growth curves over-diagnose fetal growth restriction among fetuses with gastroschisis

Fetal growth restriction (FGR) occurs in a significant proportion of pregnancies complicated by gastroschisis, however is diagnosed based on growth percentiles for non-anomalous fetuses. Due to abdominal organ herniation, fetal abdominal circumference (AC) often measures less than expected when using Hadlock biometric measurements. This may over-diagnose FGR in these fetuses. Our objective was to evaluate 2nd and 3rd trimester biometric measurements of fetuses with gastroschisis to create growth curves specific to this anomaly. This single-center retrospective cohort study included biometric data from 413 ultrasounds of 116 fetuses with isolated gastroschisis between January 2011 and July 2020. Estimated fetal weight (EFW) was calculated by Hadlock 1984. Revised growth curves were generated using gastroschisis biometric measurements, with the 10th, 50th and 90th centiles calculated. A non-parametric model and ANOVA chi-square test were used to compare gastroschisis-specific curves to Hadlock growth curves. Five growth curves were generated for gastroschisis fetuses including EFW, biparietal diameter, head circumference, AC, and femur length (FL). EFW curves for gastroschisis fetuses were significantly different than 1984 Hadlock growth curves (p<0.001). The gastroschisis 50th percentile curve virtually overlays the Hadlock 10th percentile curve. 60% of fetuses diagnosed with FGR by Hadlock were misdiagnosed based on the gastroschisis-specific growth curve. Curves for AC and FL revealed a similar pattern, with the Hadlock 50th percentile curve just below the gastroschisis 90th percentile curve. Fetuses with gastroschisis have a growth curve that is distinctly different from that defined by Hadlock. Gastroschisis fetuses are over-diagnosed with FGR when compared to non-anomalous fetuses. Given the known risks of preterm delivery, using a gastroschisis-specific growth curve may assist in risk-stratification and potentially adjust the gestational age goal to achieve among otherwise reassuring cases of gastroschisis.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Congenital Abdominal Wall Defects: A Topic Review and a Case Report of a Lethal Polymalformation Syndrome with a Giant Abdominoschisis

Abstract Abdominal wall defects (AWDs) represent a wide spectrum of congenital anomalies which are characterized by a herniation of abdominal organs through a pathologic opening in the abdominal region. The author describes a 29-year-old pregnant woman who was prenatally found to have a living female fetus with a giant omphalocele and a spinal deformation in the lumbosacral region. An evisceration of the abdominal contents into the amnionic cavity was visible. Based on USG findings the limb-body wall complex was suggested. An amniocentesis was performed and a genetic testing identified a chromosome 17q23.1–q23.2 duplication. As the fetal anomaly was considered incompatible with life, a medical termination of the pregnancy was carried out. Postmortem examination of the fetus revealed a huge abdominoschisis with a complete evisceration of the liver, stomach, small and large intestines, spleen, and the right kidney. A severe left-sided scoliosis deformity of the spine with crooked trunk was evident. The gross findings shared the features of omphalocele and limb-body wall complex with no postnatal life expectancy. Most fetal AWDs have poor prognosis. The pathology of these conditions differ greatly and require specific prenatal evaluation and pregnancy management for each entity. Accurate assessment of AWDs will allow the identification of isolated forms with better clinical outcomes compared to associated multiple malformations with chromosomal anomalies or genetic syndromes.

Rare case of diaphragmatic rupture following resuscitation in a pregnant woman first in literature

IntroductionComplications following Cardiopulmonary resuscitation (CPR) are rare and usually follows a vigorous CPR or in special cases like pregnancy are due to lack of knowledge and clinical practice of how to preform CPR in pregnancy. One of this complication is diaphragmatic rupture with herniation of abdominal organs. Surgical intervention needs to be planned carefully in multidisciplinary team approach and requires fine surgical techniques for better outcome. There are few reported cases of diaphragmatic rupture after Cardiopulmonary resuscitation but none in pregnant woman.Case presentationWe report a rare case of diaphragmatic rupture in a 29-year-old pregnant patient who experienced a full-blown diaphragmatic defect and herniation of the abdominal organs into the thoracic cavity, as a complication of CPR. Following careful assessment and diagnosis, the patient underwent urgent laparotomy with reduction of the contents and primary closure of the defect. One year follow up was satisfactory. To the best of our knowledge, this is the first reported case of diaphragmatic rupture with herniation of the abdominal organs following CPR in a pregnant woman in the literature.ConclusionThe application of external cardiac massage through CPR is a life-saving procedure for the management of cardiac arrest. Common complications related to CPR include rib fractures, sternal fractures and haemothorax. Diaphragmatic rupture with herniation of the abdominal organs is a rare complication, having been reported only once in the literature (Sabzi F, Faraji R, Tanaffos 16:170–172, 2017); however, it represents a serious and life-threating event. Thus, careful evaluation of the patient by a multidisciplinary team and prompt intervention is recommended in order to improve outcomes.

Traumatic right hemi-diaphragmatic injury: delayed diagnosis

BackgroundTraumatic diaphragmatic injury is known to present with the spectrum of symptoms, and most patients would have some symptoms due to abdominal organ herniation. Majority of injuries tend to present on the left hemidiaphragm but right-sided injuries also occur mostly with subtle, delayed presentation due to the buffering effect of the liver.Case presentationA 65-year-old male presented to the emergency department with a complaint of nausea and vomiting and reported no bowel movement or passing of flatus for 5 days. Upon further questioning, he recalled that he fell from a tractor while working in his farm 2 months earlier and sustained blunt trauma to his abdomen. Both chest and abdominal X-rays revealed the niveau formation of the small intestine on the right side above the liver and right hemidiaphragm. Further evaluation with CT scan confirmed the presence of a few small intestinal loops behind the liver and also in the chest through a rupture in the right hemidiaphragm. Exploratory laparotomy was performed. Some small intestine loops had gone behind the liver and through 4 cm rupture in the posterior aspect of the diaphragm into the chest. Displaced intestinal loops were relocated and no sign of ischemia or necrosis was observed. The patient was symptom-free within 2 days and he was discharged after 4 days.ConclusionTraumatic injuries of the diaphragm are rare, yet underestimated; therefore, they need a high index of suspicion for timely diagnosis and neglected diagnosis may present with a range of symptoms such as herniation months to years later.

A report of two pediatric cases of Morgagni Hernia

Background: Morgagni hernia (MH) is a rare congenital anomaly of the diaphragm. It is a birth defect characterized by herniation of abdominal organs into the thoracic cavity through a retrosternal diaphragmatic defect which inhibits proper lung formation. Case presentation: We report two cases of MH in a set of premature twins aged 9 days, who presented with respiratory distress at King Abdulaziz Medical City, Jeddah. The diagnosis was confirmed by imaging of chest X-ray and CT scan. Both cases were successfully managed through abdominal approach i.e. laparotomy with surgical treatment of the diaphragmatic deformity. Conclusion: The exact pathogenesis of most cases of congenital diaphragmatic hernia (CDH) remains unknown, however there is an increasing evidence indicating that genetic factors play a pivotal role in formation of CDH. Moreover, its occurrence in a set of twins further supports the genetical theory.

Traumatic Diaphragmatic Lesions - Considerations Over a Series of 15 Consecutive Cases.

Introduction: Diaphragmatic injuries are produced by blunt or penetrating thoracoabdominal trauma. They are potentially life-threatening due to the herniation of abdominal organs into the pleural cavities and severe associated lesions. The aim of this retrospective study was to analyse the clinical presentation and management of patients admitted with diaphragmatic rupture in our institution. Material and Method: We performed a 5-year retrospective study of patients admitted with acute blunt or penetrating diaphragmatic rupture in the Department of General Surgery of "Bagdasar- Arseni" Emergency Hospital. We have studied sex, age, mechanism of trauma, side-location, timeto-diagnosis, concomitant injuries, surgical treatment and outcome. Results: Fifteen patients (8 males, 7 females, mean age: 42 years) with diaphragmatic rupture (left-side: 13, right-side: 2) following blunt (8 patients) or penetrating (7) trauma were included. Patients with blunt diaphragmatic injury had larger tears and abdominal viscera herniation was observed in 6of these cases. A direct suture was performed for all 15 patients. Laparotomy was the surgical approach preferred in most of the cases. Mortality rate was 20%, mainly caused by severe associated lesions. Conclusion: Although traumatic diaphragmatic lesions are frequently associated with severe cerebral and thoraco-abdominal trauma that is also the main cause of death, a prompt diagnosis and treatment can lead to good outcome.

Characterization of a reversible thermally-actuated polymer-valve: A potential dynamic treatment for congenital diaphragmatic hernia.

BackgroundCongenital diaphragmatic hernia (CDH) is a fetal defect comprising an incomplete diaphragm and the herniation of abdominal organs into the chest cavity that interfere with fetal pulmonary development. Though the most promising treatment for CDH is via interventional fetoscopic tracheal occlusion (TO) surgery in-utero, it has produced mixed results due to the static nature of the inserted occlusion. We hypothesize that a suitable noninvasively-actuatable, cyclic-release tracheal occlusion device can be developed to enable dynamic tracheal occlusion (dTO) implementation.ObjectiveTo conduct an in-vitro proof-of-concept investigation of the construction of thermo-responsive polymer valves designed for targeted activation within a physiologically realizable temperature range as a first step towards potential development of a noninvasively-actuatable implantable device to facilitate dynamic tracheal occlusion (dTO) therapy.MethodsSix thermo-responsive polymer valves, with a critical solution temperature slightly higher than normal physiological body temperature of 37°C, were fabricated using a copolymer of n-isopropylacrylamide (NIPAM) and dimethylacrylamide (DMAA). Three of the valves underwent ethylene oxide (EtO) sterilization while the other three served as controls for EtO-processing compatibility testing. Thermal response actuation of the valves and their steady-state flow performances were evaluated using water and caprine amniotic fluid.ResultsAll six valves consisting of 0.3-mole fraction of DMAA were tested for thermal actuation of caprine amniotic fluid flow at temperatures ranging from 30–44°C. They all exhibited initiation of valve actuation opening at ~40°C with full completion at ~44°C. The overall average coefficient of variation (CV) for the day-to-day flow performance of the valves tested was less than 12%. Based on a Student t-test, there was no significant difference in the operational characteristics for the EtO processed versus the non-EtO processed valves tested.ConclusionsWe successfully fabricated and demonstrated physiological realizable temperature range operation of thermo-responsive polymer valves in-vitro and their suitability for standard EtO sterilization processing, a prerequisite for future in-vivo surgical implantation testing.

CHRONIC COUGH CAUSING AN UNEXPECTED COMPLICATION

SESSION TITLE: Medical Student/Resident Signs and Symptoms of Chest Diseases SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Cough is a physiologic defense mechanism to protect airways from foreign material and secretions. It’s one of the most common symptoms responsible of outpatient clinic evaluation and consists of approximately 30 million of visits annually in United States. Can be classified upon the duration on acute (less than 3 weeks), subacute (3 to 8 weeks) and chronic (more than 8 weeks). Sustained cough can be associated with multiple complications including cardiovascular, gastrointestinal, genitourinary, musculoskeletal, ophthalmologic, psychosocial, respiratory and skin complications. The most frequent documented is rib fractures. Other less reported complications include muscle rupture and pneumothorax CASE PRESENTATION: A 72yo woman G3P3A0 with morbid obesity, hypertension, fibromyalgia, diabetes mellitus type 2 and sleep apnea on Bipap with no toxic habits who presents with a chief complaint of dry cough and progressive shortness of breath of approximately 1 year evolution, with multiple visit to primary physician as well as emergency room without improvement of symptoms and treated with antibiotic therapy for pneumonic process. She continued with cough not responsive to medical management developing a tearing abdominal pain that radiate to the back and upper chest associated ecchymosis, worsening of dyspnea, early satiety, left breast pain and an episode of syncope. She denied fever, sputum, or recent trauma. Chest Xray performed on multiple occasions without evidence of abnormality. Chest CT with contrast showed a diaphragmatic rupture with displacement of small and large bowel into left side thoracic cavity causing left pulmonary collapse. Thoracic surgery was performed with placement of intestine on abdominal cavity, correction of diaphragmatic rupture and chest tube placement for pneumothorax. After procedure patient reported resolution of dyspnea. DISCUSSION: Diaphragm is an inspiratory muscle, which contracts during expiratory phase. Valsalva maneuver results in lack coordination of different muscles of expiration, the muscle of the abdominal wall contracts pushing the diaphragm upward whereas the ribs are pushed inward and downward causing diaphragmatic rupture. This complication is caused by thoracic injury in 7% and by thracoabdominal injury in 22% of cases. Herniation of bowel loops into the chest can be a consequence of diaphragmatic rupture, which impairs ventilation and oxygen delivery. The true incidence of abdominal organ herniation due to diaphragmatic rupture is unknown since many cases likely go undiagnosed. Diaphragmatic rupture has an overall mortality rate of 25% as reported by the National Trauma Data Bank. CONCLUSIONS: Due to an increase rate of herniation and strangulation of abdominal organs secondary to diaphragmatic rupture, which can be life threatening and surgical procedure is life saving; physician should be aware of the uncommon complication of cough. Reference #1: Hillenbrand A, Henne-Bruns, D. Cough induced rib fracture, rupture of the diaphragm and abdominal herniation. World Journal of Emergency Surgery 2006, 1:34 DISCLOSURES: No relevant relationships by Aixa Dones Rodriguez, source=Web Response No relevant relationships by Marlene Farinacci Vilaro, source=Web Response No relevant relationships by Ricardo Fernandez, source=Web Response No relevant relationships by Luis Gerena Montano, source=Web Response No relevant relationships by Hernan Gonzalez Monroig, source=Web Response No relevant relationships by Modesto Gonzalez-del Rosario, source=Web Response

Prenatal intervention for the management of congenital diaphragmatic hernia.

Congenital diaphragmatic hernia (CDH) is the result of incomplete formation of the diaphragm that occurs during embryogenesis. The defect in the diaphragm permits the herniation of abdominal organs into the thoracic cavity contributing to the impairment of normal growth and development of the fetal lung. In addition to the hypoplastic lung, anomalies of the pulmonary arterioles worsen the pulmonary hypertension that can have detrimental effects in severe cases. Most cases of CDH can be effectively managed postnatally. Advances in neonatal and surgical care have resulted in improved outcomes over the years. When available, extracorporeal membrane oxygenation can provide temporary cardiorespiratory support for those not effectively supported by mechanical ventilation. In spite of these advances, very severe cases of CDH still carry a very high mortality and morbidity rate. Advances in imaging and evaluation now allow for early and accurate prenatal diagnosis of CDH, thereby identifying those at greatest risk who may benefit from prenatal intervention. This review article discusses some of the surgical and non-surgical prenatal interventions in the management of isolated severe congenital diaphragmatic hernia.