Delayed Surgery for Congenital Diaphragmatic Hernia

Infants with congenital diaphragmatic hernia (CDH) operated on at 12 hours of age have poor prognosis. Development of severe hypoxemia due to hypoplastic lung and pulmonary vascular constriction is the major prognostic factor. Infants who show reasonable gas exchange at first but develop severe hypoxemia a few hours following surgery (honeymoon period) may have benefited from delayed radical surgery. During the waiting period, the patient should be kept on a minimal handling and stabilizing protocol. In our institute, 24 CDH patients were treated from 1970 to 1995. These patients were divided into two groups : group I (n = 11) was the first stage (1970-1984), group II (n = 13) was the second stage (1985-1995). The total survival rate of these two groups did not improve. However our experience with the last six cases using this stabilizing protocol between 1989 and 1995 suggests that delayed repair surgery for CDH improved the survival rate. The survival rate changed from 33.3% in group I to 44.4% in group II. We report our cases, including clinical status, surgical findings and treatments

Surgical resection of symptomatic pneumatoceles in a <600 gm premature infant

Persistent interstitial pulmonary emphysema (PIPE) is rare and usually related to mechanical ventilation-induced lung damage in premature infants with respiratory distress syndrome (RDS). When conservative treatments for PIPE, such as surfactant treatment, steroid therapy, or selective intubation, are ineffective, surgical intervention should be considered. Although PIPE localized in one lobe has the potential for curative resection, diffuse PIPE (DPIPE) affecting both lungs usually carries a poor prognosis.Tension pneumatocele by ipsilateral expanded cyst in DPIPE may need surgical treatment in case of emergency. We present a rare case of an extremely low birth weight infant who required surgical intervention for tension pneumatocele due to DPIPE and propose the indications for surgery of tension pneumatocele with DPIPE. Keywords: Interstitial pulmonary emphysema, Tension pneumatocele, Extremely low birth weight infant, Surgical resectio

Complete allogeneic hematopoietic chimerism achieved by in utero hematopoietic cell transplantation and cotransplantation of LLME-treated, MHC-sensitized donor lymphocytes

Objective. In utero hematopoietic cell transplantation (IUHCT) typically achieves low-level mixed hematopoietic chimerism. However, the goal of IUHCT is to achieve therapeutic levels of chimerism. We hypothesized that prenatal adoptive immunotherapy might achieve high-level donor chimerism after IUHCT. Materials and Methods. BALB/CE15 fetal mice were transplanted with a mixture of C57BL/6 (B6) T-cell-depleted bone marrow (TCD BM) cells and splenocytes from B6 mice presensitized to BALB/C alloantigen. The splenocytes were preincubated in L-leucyl-L-leucine methyl ester (LLME), to minimize graft vs host disease (GVHD). Recipients were followed after birth for donor cell chimerism and GVHD. Results. Full donor hematopoietic chimerism following a single prenatal transplant was achieved in seven transplanted animals. Fully chimeric animals were healthy, without evidence of GVHD, and maintained their engraftment for the duration of the study (48 weeks). However, the addition of presensitized LLME-treated cells decreased survival until weaning relative to TCD BM alone, suggesting that some animals were lost to acute GVHD. Surviving chimeric animals demonstrated increased frequencies of T-regulatory cell populations in their spleen and BM, suggesting that they had successfully suppressed GVHD, allowing survival. Conclusions. This study represents proof in principle that prenatal immunotherapeutic strategies may achieve complete hematopoietic engraftment across full MHC barriers when combined with IUHCT. However, strategies with greater hematopoietic specificity must be developed prior to consideration of clinical application. © 2004 International Society for Experimental Hematology. Published by Elsevier Inc

Delayed Surgery for Congenital Diaphragmatic Hernia

Infants with congenital diaphragmatic hernia (CDH) operated on at 12 hours of age have poor prognosis. Development of severe hypoxemia due to hypoplastic lung and pulmonary vascular constriction is the major prognostic factor. Infants who show reasonable gas exchange at first but develop severe hypoxemia a few hours following surgery (honeymoon period) may have benefited from delayed radical surgery. During the waiting period, the patient should be kept on a minimal handling and stabilizing protocol. In our institute, 24 CDH patients were treated from 1970 to 1995. These patients were divided into two groups : group I (n = 11) was the first stage (1970-1984), group II (n = 13) was the second stage (1985-1995). The total survival rate of these two groups did not improve. However our experience with the last six cases using this stabilizing protocol between 1989 and 1995 suggests that delayed repair surgery for CDH improved the survival rate. The survival rate changed from 33.3% in group I to 44.4% in group II. We report our cases, including clinical status, surgical findings and treatments

Endovascular treatment for hemothorax via contralateral internal thoracic artery branch after Nuss procedure – A case report

The Nuss procedure is performed widely as a standard surgical treatment for pectus excavatum. Compared to conventional methods, the Nuss procedure excels in cosmetic terms and involves fewer complications. A 14-year-old boy developed right hemothorax with a sudden shock one month after the Nuss procedure. We identified the bleeding from left internal thoracic artery (ITA) branch and achieved hemostasis by endovascular coil embolization. To the best of our knowledge, this is the first to report that the ITA on the contralateral side of the hemothorax was responsible for the bleeding