Background/Purpose: A few studies have taken into account the diaphragmatic function in patients successfully treated for congenital diaphragmatic hernia (CDH). Monodimensional sonography has been reported to be usefu...Background/Purpose: A few studies have taken into account the diaphragmatic function in patients successfully treated for congenital diaphragmatic hernia (CDH). Monodimensional sonography has been reported to be useful in assessing the diaphragmatic motility. Aim of the present study was to investigate, in a long-term follow-up, the diaphragmatic function after CDH repair. Methods: Ten patients, with a mean age of 16 (5- 26) years, were enrolled. All had had a left diaphragmatic hernia repaired, but no one received a patch. Ten subjects of matched age were used as controls. The diaphragmatic excursions appear, at M-mode sonography, as a sinusoid; the amplitude of the curve on the vertical axis measured the movement in centimeters. Chest x-ray and spirometry were also performed in CDH patients. Results: A reduced diaphragmatic motility on the left (treated) side was recorded. The amplitude of the contraction was significantly reduced when compared with the contralateral side (1.19 ± 0.2 vs 2.33± 0.9 cm; P = .017) and was also significantly reduced in comparison with the motion of the left side of controls (1.19 ± 0.2 vs 1.83 ± 0.4 cm; P = .01). There was no difference in the amplitude of contraction between the left and right sides of control patients and between the right side of CDH patients and the controls. Spirometry was normal in all patients but one, who had a slight reduction of ventilation on the left side. Conclusion: M-mode sonography appears as a very useful tool in quantitative evaluation of diaphragmatic movements and should be extensively used during follow-up of patients after CDH repair. Motility of the repaired diaphragmatic is reduced, even after a long period, but this does not affect the respiratory function in patients who survived CDH repair.展开更多
Background and Purpose: Constipation is one of the major sequelae in patients after correction of anorectal anomalies (ARAs). The aim of the present work has been to assess the colonic transit time,using radioisotope ...Background and Purpose: Constipation is one of the major sequelae in patients after correction of anorectal anomalies (ARAs). The aim of the present work has been to assess the colonic transit time,using radioisotope scintigraphy,in patients operated for ARA and experiencing constipation in the follow-up. The results were compared with transit time from children with true functional constipation. Methods: Twelve or 32 patients operated for ARA during the period 1994-2003 experienced mild or severe constipation (6 with high or intermediate form of ARA and 6 with low type) at follow-up. The mean age of this group was 5.8 years. Eighteen patients,mean age 6.7 years,with true functional constipation were studied as well. Colonic transit times were investigated using radioisotope scintigraphy. Normal values for colonic transit time were derived from historical controls. Radioisotope diethylenetriamine pentaacetic acid labelled with indium 111 was administered orally to determine a segmental colonic transit. Images of the abdomen have been taken at 6,24,48,and again at 72 hours,if radioactivity was not cleared from the colon. To quantify colonic transit,we calculated the geometric centre (GC) dividing the colon into anatomic regions. Results: According to normal controls,2 different type of delayed transit can be observed: (a) slow-transit constipation if GC at 48 hours is less than 4.1; (b) functional rectosigmoid obstruction (FRSO) if GC at 48 hours is 4.1 or more but less than 6.1 at 72 hours. Patients with functional constipation were divided into 2 groups: (a)-slow-transit constipation in 12 patients with a GC at 48 hours of 3.7 ± 0.5; (b) FRSO in 6 patients with a GC of 4.7 ± 0.04 and 5.02 at 48 and 72 hours,respectively. Patients operated for high ARA had values characteristic of FRSO with GC at 48 hours of 5.1 ± 0.8 and 4.75 ± 0.5 at 72 hours. In low ARA,the transit times were similar to the ones observed in patients with high ARA at 48 hours with a GC of 4.9 ± 0.5. Conclusions: Patients with ARA frequently have functional sequelae in the postoperative period such as constipation. According to our results,constipation seems to be secondary to segmental motility disorders limited to the rectosigmoid area,similar to constipated children with FRSO. No evidence of more gener-alised motility disturbance,as previously postulated,could be recorded.展开更多
文摘Background/Purpose: A few studies have taken into account the diaphragmatic function in patients successfully treated for congenital diaphragmatic hernia (CDH). Monodimensional sonography has been reported to be useful in assessing the diaphragmatic motility. Aim of the present study was to investigate, in a long-term follow-up, the diaphragmatic function after CDH repair. Methods: Ten patients, with a mean age of 16 (5- 26) years, were enrolled. All had had a left diaphragmatic hernia repaired, but no one received a patch. Ten subjects of matched age were used as controls. The diaphragmatic excursions appear, at M-mode sonography, as a sinusoid; the amplitude of the curve on the vertical axis measured the movement in centimeters. Chest x-ray and spirometry were also performed in CDH patients. Results: A reduced diaphragmatic motility on the left (treated) side was recorded. The amplitude of the contraction was significantly reduced when compared with the contralateral side (1.19 ± 0.2 vs 2.33± 0.9 cm; P = .017) and was also significantly reduced in comparison with the motion of the left side of controls (1.19 ± 0.2 vs 1.83 ± 0.4 cm; P = .01). There was no difference in the amplitude of contraction between the left and right sides of control patients and between the right side of CDH patients and the controls. Spirometry was normal in all patients but one, who had a slight reduction of ventilation on the left side. Conclusion: M-mode sonography appears as a very useful tool in quantitative evaluation of diaphragmatic movements and should be extensively used during follow-up of patients after CDH repair. Motility of the repaired diaphragmatic is reduced, even after a long period, but this does not affect the respiratory function in patients who survived CDH repair.
文摘Background and Purpose: Constipation is one of the major sequelae in patients after correction of anorectal anomalies (ARAs). The aim of the present work has been to assess the colonic transit time,using radioisotope scintigraphy,in patients operated for ARA and experiencing constipation in the follow-up. The results were compared with transit time from children with true functional constipation. Methods: Twelve or 32 patients operated for ARA during the period 1994-2003 experienced mild or severe constipation (6 with high or intermediate form of ARA and 6 with low type) at follow-up. The mean age of this group was 5.8 years. Eighteen patients,mean age 6.7 years,with true functional constipation were studied as well. Colonic transit times were investigated using radioisotope scintigraphy. Normal values for colonic transit time were derived from historical controls. Radioisotope diethylenetriamine pentaacetic acid labelled with indium 111 was administered orally to determine a segmental colonic transit. Images of the abdomen have been taken at 6,24,48,and again at 72 hours,if radioactivity was not cleared from the colon. To quantify colonic transit,we calculated the geometric centre (GC) dividing the colon into anatomic regions. Results: According to normal controls,2 different type of delayed transit can be observed: (a) slow-transit constipation if GC at 48 hours is less than 4.1; (b) functional rectosigmoid obstruction (FRSO) if GC at 48 hours is 4.1 or more but less than 6.1 at 72 hours. Patients with functional constipation were divided into 2 groups: (a)-slow-transit constipation in 12 patients with a GC at 48 hours of 3.7 ± 0.5; (b) FRSO in 6 patients with a GC of 4.7 ± 0.04 and 5.02 at 48 and 72 hours,respectively. Patients operated for high ARA had values characteristic of FRSO with GC at 48 hours of 5.1 ± 0.8 and 4.75 ± 0.5 at 72 hours. In low ARA,the transit times were similar to the ones observed in patients with high ARA at 48 hours with a GC of 4.9 ± 0.5. Conclusions: Patients with ARA frequently have functional sequelae in the postoperative period such as constipation. According to our results,constipation seems to be secondary to segmental motility disorders limited to the rectosigmoid area,similar to constipated children with FRSO. No evidence of more gener-alised motility disturbance,as previously postulated,could be recorded.
