Background and Aim: Long-term respiratory, gastrointestinal, and vertebral sequelae are common after repair of congenital diaphragmatic defects (CDDs). The aim of this study was to assess the effect of these sequelae ...Background and Aim: Long-term respiratory, gastrointestinal, and vertebral sequelae are common after repair of congenital diaphragmatic defects (CDDs). The aim of this study was to assess the effect of these sequelae on the health-related quality of life (HRQoL) of adult survivors after CDD repair. Materials and Methods: A questionnaire, including 36-Item Health Survey Form (SF-36), 36-item Gastrointestinal Quality of Life Index (GIQLI), 55-item Psychosocial Survey, 9-item survey for Respiratory Symptoms-Related Quality of Life Index, and a symptoms query, was sent to 94 adult survivors of CDD and to 400 healthy control subjects. One SD lower than the age-adjusted national average in the 36-Item Health Survey Form score for physical or mental health was considered as low HRQoL. Results: Sixty-nine patients with CDD (72% ) and 162 (41% ) control subjects returned the questionnaire. The initial presentation was critical in less than 10% of patients with CDD. Forty-five patients with diaphragmatic hernia had primary closure; in 1 patient with diaphragmatic hernia, a patch was used. Twenty-four patients had plication of diaphragmatic eventration. The incidence of gastroesophageal reflux (20% vs 2% ), recurrent intestinal obstruction (7% vs 0% ), and recurrent abdominal pain (12% vs 2% ) was significantly higher in patients with CDD than in control subjects, whereas no difference in the incidence of respiratory, musculoskeletal, or other health problems not associated with CDD was found. Scores in GIQLI, Psychosocial Survey, and Respiratory Symptoms-Related Quality of Life Index did not differ between patients with CDD and control subjects. Health-related quality of life was low in 17 (25% ) of 69 patients with CDD, which exceeded 1.5 times the expected value. There was no correlation between the type or severity of the primary defect and HRQoL at the time of the study. Conclusion: Most adults with repaired CDD have good or satisfactory HRQoL. Congenital diaphragmatic defect-associated symptoms with or without acquired diseases significantly impair HRQoL in one fourth of the patients.展开更多
目的探讨维生素A(vitamin A,VA)缺乏在新生大鼠胎粪吸入综合征(meconium aspiration syndrome,MAS)中对肺损伤的影响。方法通过饲养VA缺乏及VA正常母鼠获得新生7 d VA缺乏SD大鼠(vitamin A deficiency,VAD)及VA正常新生SD大鼠(vitamin A...目的探讨维生素A(vitamin A,VA)缺乏在新生大鼠胎粪吸入综合征(meconium aspiration syndrome,MAS)中对肺损伤的影响。方法通过饲养VA缺乏及VA正常母鼠获得新生7 d VA缺乏SD大鼠(vitamin A deficiency,VAD)及VA正常新生SD大鼠(vitamin A normal,VAN)各25只,分别建立VA缺乏MAS模型(VAD组)及VA正常MAS模型(VAN组)。记录、对比、分析各组新生SD大鼠血气分析、肺组织湿/干质量比、HE染色评估肺组织损伤;ELISA检测肺组织SP-A蛋白、SP-C蛋白、IL-6、血管内皮生长因子(vascular endothelial growth factor,VEGF)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)含量;高效液相色谱检测肺组织β-丙氨酸及其他代谢组物指标。结果与VAN组比较,VAD组新生大鼠血气中pH值(P=0.003)、碱剩余(base excess,BE)(P=0.019)显著降低,差异有统计学意义;VAD组血气中CO_(2)分压(PCO_(2))(P=0.049)、肺组织的湿/干质量比(P=0.001)、IL-6(P=0.002)、VEGF(P=0.003)、TNF-α(P=0.019)显著增高,提示VAD组肺组织炎症反应更重。代谢组学分析表明:两组之间主要差异信号通路包括β-丙氨酸代谢通路、cGMP-PKG信号通路、嗅觉转导通路、神经活性配体-受体相互作用通路等,进一步通过液相色谱质谱技术检测并验证发现VAD组较VAN组中β-丙氨酸(P=0.000)显著上调。结论VA缺乏可通过上调MAS的炎症因子的表达加重肺损伤,这可能与VA缺乏后导致β-丙氨酸代谢通路改变有关。展开更多
A 67-year-old woman with chronic cholecystitis was scheduled to have laparoscopic cholecystectomy under general anesthesia. About 5-10 min after the CO2 intraperitoneal insuffiation, the peak airway pressure gradually...A 67-year-old woman with chronic cholecystitis was scheduled to have laparoscopic cholecystectomy under general anesthesia. About 5-10 min after the CO2 intraperitoneal insuffiation, the peak airway pressure gradually increased from 15 cmH2O to 27 cmH2O, the endtidal CO2（EtCO2） from 32 mmHg to 56 mmHg. The SpO2 decreased from 100% to 96%, and blood pressure from 135/80 mmHg to 80/ 52 mmHg. A right side tension pneumothorax was confirmed and a drainage tube was placed in the right pleural cavity. As the continuous gas leakage from the drainage tube was noted, even as ventilation was withheld, the diaphragm was carefully examined and a porous diaphragm was found. These defects were then patched with biomedical materials. The operation was finished uneventfully. It was concluded that in apatient with a tension pneumothorax during laparoscopic surgery, a diaphragm defect should be taken into consideration.展开更多
文摘Background and Aim: Long-term respiratory, gastrointestinal, and vertebral sequelae are common after repair of congenital diaphragmatic defects (CDDs). The aim of this study was to assess the effect of these sequelae on the health-related quality of life (HRQoL) of adult survivors after CDD repair. Materials and Methods: A questionnaire, including 36-Item Health Survey Form (SF-36), 36-item Gastrointestinal Quality of Life Index (GIQLI), 55-item Psychosocial Survey, 9-item survey for Respiratory Symptoms-Related Quality of Life Index, and a symptoms query, was sent to 94 adult survivors of CDD and to 400 healthy control subjects. One SD lower than the age-adjusted national average in the 36-Item Health Survey Form score for physical or mental health was considered as low HRQoL. Results: Sixty-nine patients with CDD (72% ) and 162 (41% ) control subjects returned the questionnaire. The initial presentation was critical in less than 10% of patients with CDD. Forty-five patients with diaphragmatic hernia had primary closure; in 1 patient with diaphragmatic hernia, a patch was used. Twenty-four patients had plication of diaphragmatic eventration. The incidence of gastroesophageal reflux (20% vs 2% ), recurrent intestinal obstruction (7% vs 0% ), and recurrent abdominal pain (12% vs 2% ) was significantly higher in patients with CDD than in control subjects, whereas no difference in the incidence of respiratory, musculoskeletal, or other health problems not associated with CDD was found. Scores in GIQLI, Psychosocial Survey, and Respiratory Symptoms-Related Quality of Life Index did not differ between patients with CDD and control subjects. Health-related quality of life was low in 17 (25% ) of 69 patients with CDD, which exceeded 1.5 times the expected value. There was no correlation between the type or severity of the primary defect and HRQoL at the time of the study. Conclusion: Most adults with repaired CDD have good or satisfactory HRQoL. Congenital diaphragmatic defect-associated symptoms with or without acquired diseases significantly impair HRQoL in one fourth of the patients.
文摘A 67-year-old woman with chronic cholecystitis was scheduled to have laparoscopic cholecystectomy under general anesthesia. About 5-10 min after the CO2 intraperitoneal insuffiation, the peak airway pressure gradually increased from 15 cmH2O to 27 cmH2O, the endtidal CO2（EtCO2） from 32 mmHg to 56 mmHg. The SpO2 decreased from 100% to 96%, and blood pressure from 135/80 mmHg to 80/ 52 mmHg. A right side tension pneumothorax was confirmed and a drainage tube was placed in the right pleural cavity. As the continuous gas leakage from the drainage tube was noted, even as ventilation was withheld, the diaphragm was carefully examined and a porous diaphragm was found. These defects were then patched with biomedical materials. The operation was finished uneventfully. It was concluded that in apatient with a tension pneumothorax during laparoscopic surgery, a diaphragm defect should be taken into consideration.
