Thoracoscopic Repair of Recurrent Bochdalek Diaphragmatic Hernias in Children

Abstract Background: Recurrent herniation is a well-known complication following the initial repair of congenital diaphragmatic hernias (CDHs). The role of minimally invasive surgical techniques in recurrent CDH remains undefined. The purpose of this study was to evaluate our early experience with thoracoscopic repair compared with traditional open repair in children with recurrent CDH. Subjects and Methods: We retrospectively reviewed all recurrent Bochdalek CDH cases (n=24) managed at a single tertiary-care referral center between January 1990 and March 2011. Children who underwent thoracoscopic repair for recurrent CDH were identified, and their data were compared by the unpaired t test and the two-sided Fisher's exact test, as appropriate, with those of children who underwent open repair. Significance was defined as P<.05. Results: Thoracoscopic repair was attempted in 6 (25%) children with recurrent CDH. Four (67%) repairs were successfully completed without conversion to an open procedure. The mean age at thoracoscopic repair was 11.5 months (range, 8.1?16.1 months). The mean operative time was 191 minutes (range, 94?296 minutes), and all children were extubated within 24 hours. The mean hospital length of stay was 3.75 days (range, 1?6 days). There were no deaths or subsequent recurrences after a mean follow-up of 26.5 months (range, 14.3?41.3 months). There were no statistical differences in any of the measured outcome variables when compared with the open repair group. Conclusions: Our initial experience suggests that thoracoscopic repair is a feasible alternative to open repair in selected children with recurrent Bochdalek diaphragmatic hernias.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/98467/1/lap%2E2012%2E0048.pd

A novel synthesis of substituted 3‐amino and 3‐thio pyrimido[5,4‐e]‐1,2,4‐triazine‐5,7(1H,6H)‐diones

Fervenulin is a natural product that has been extensively studied due to its molecular features and breadth of biological activities. Published studies have reported the generation of numerous analogues of the bicyclic pyrimidotriazinodione core. One underrepresented subclass are compounds with electron releasing atoms bonded directly to the C‐3 position. We report an efficient and straightforward synthesis of compounds with substituted amino and thio functionality attached to the C‐3 position. These are derived from a common 3‐chloro precursor that is made in six steps in 15.8% overall yield from a starting chlorouracil. Our methodology should be applicable to the synthesis of C‐3 ether congeners also, and through previously described chemistry be expandable to incorporating diversity at the N‐6 position of the pyrimidotriazinodione core. The chemistry reported herein expands possibilities for the generation of diverse libraries of substituted pyrimidotriazinediones for future studies.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/169339/1/jhet4263_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/169339/2/jhet4263.pd