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Kerilyn K Nobuhara - One of the best experts on this subject based on the ideXlab platform.

  • Congenital Diaphragmatic Hernia associated with spinal anomalies.
    Obstetrics & Gynecology, 2007
    Co-Authors: Erich J Grethel, Hanmin Lee, Jody A. Farrell, Robert H. Ball, Kerilyn K Nobuhara
    Abstract:

    OBJECTIVE:Increased mortality is seen in patients with Congenital Diaphragmatic Hernia who have associated anomalies, such as cardiac defects. We reviewed our series of patients with Congenital Diaphragmatic Hernia and spinal anomalies to evaluate if their prognosis was altered.METHODS:We examined o

  • Congenital Diaphragmatic Hernia associated with spinal anomalies.
    Obstetrics and gynecology, 2007
    Co-Authors: Erich J Grethel, Jody Farrell, Robert Ball, Hanmin Lee, Kerilyn K Nobuhara
    Abstract:

    Increased mortality is seen in patients with Congenital Diaphragmatic Hernia who have associated anomalies, such as cardiac defects. We reviewed our series of patients with Congenital Diaphragmatic Hernia and spinal anomalies to evaluate if their prognosis was altered. We examined our institutional database from August 1995 to August 2005, examining 679 cases of Congenital Diaphragmatic Hernia, identifying all fetuses and newborns with Congenital Diaphragmatic Hernia and spinal anomalies. Patients who had both Congenital Diaphragmatic Hernia and spinal anomalies were identified by prenatal ultrasound reports, postnatal radiographs, operative notes, and pathology reports. Seven patients were identified in the fetal or neonatal period with concomitant diagnoses of Congenital Diaphragmatic Hernia and spinal anomalies. All patients had normal karyotype analysis. Six of these patients had both defects diagnosed using prenatal ultrasonography. All patients died before hospital discharge. Although the numbers are limited in our series, patients with Congenital Diaphragmatic Hernia and spinal anomalies have a dismal prognosis. This finding has significant implications for prenatal counseling. III.

Erich J Grethel - One of the best experts on this subject based on the ideXlab platform.

  • Congenital Diaphragmatic Hernia associated with spinal anomalies.
    Obstetrics & Gynecology, 2007
    Co-Authors: Erich J Grethel, Hanmin Lee, Jody A. Farrell, Robert H. Ball, Kerilyn K Nobuhara
    Abstract:

    OBJECTIVE:Increased mortality is seen in patients with Congenital Diaphragmatic Hernia who have associated anomalies, such as cardiac defects. We reviewed our series of patients with Congenital Diaphragmatic Hernia and spinal anomalies to evaluate if their prognosis was altered.METHODS:We examined o

  • Congenital Diaphragmatic Hernia associated with spinal anomalies.
    Obstetrics and gynecology, 2007
    Co-Authors: Erich J Grethel, Jody Farrell, Robert Ball, Hanmin Lee, Kerilyn K Nobuhara
    Abstract:

    Increased mortality is seen in patients with Congenital Diaphragmatic Hernia who have associated anomalies, such as cardiac defects. We reviewed our series of patients with Congenital Diaphragmatic Hernia and spinal anomalies to evaluate if their prognosis was altered. We examined our institutional database from August 1995 to August 2005, examining 679 cases of Congenital Diaphragmatic Hernia, identifying all fetuses and newborns with Congenital Diaphragmatic Hernia and spinal anomalies. Patients who had both Congenital Diaphragmatic Hernia and spinal anomalies were identified by prenatal ultrasound reports, postnatal radiographs, operative notes, and pathology reports. Seven patients were identified in the fetal or neonatal period with concomitant diagnoses of Congenital Diaphragmatic Hernia and spinal anomalies. All patients had normal karyotype analysis. Six of these patients had both defects diagnosed using prenatal ultrasonography. All patients died before hospital discharge. Although the numbers are limited in our series, patients with Congenital Diaphragmatic Hernia and spinal anomalies have a dismal prognosis. This finding has significant implications for prenatal counseling. III.

Hanmin Lee - One of the best experts on this subject based on the ideXlab platform.

  • Congenital Diaphragmatic Hernia associated with spinal anomalies.
    Obstetrics & Gynecology, 2007
    Co-Authors: Erich J Grethel, Hanmin Lee, Jody A. Farrell, Robert H. Ball, Kerilyn K Nobuhara
    Abstract:

    OBJECTIVE:Increased mortality is seen in patients with Congenital Diaphragmatic Hernia who have associated anomalies, such as cardiac defects. We reviewed our series of patients with Congenital Diaphragmatic Hernia and spinal anomalies to evaluate if their prognosis was altered.METHODS:We examined o

  • Congenital Diaphragmatic Hernia associated with spinal anomalies.
    Obstetrics and gynecology, 2007
    Co-Authors: Erich J Grethel, Jody Farrell, Robert Ball, Hanmin Lee, Kerilyn K Nobuhara
    Abstract:

    Increased mortality is seen in patients with Congenital Diaphragmatic Hernia who have associated anomalies, such as cardiac defects. We reviewed our series of patients with Congenital Diaphragmatic Hernia and spinal anomalies to evaluate if their prognosis was altered. We examined our institutional database from August 1995 to August 2005, examining 679 cases of Congenital Diaphragmatic Hernia, identifying all fetuses and newborns with Congenital Diaphragmatic Hernia and spinal anomalies. Patients who had both Congenital Diaphragmatic Hernia and spinal anomalies were identified by prenatal ultrasound reports, postnatal radiographs, operative notes, and pathology reports. Seven patients were identified in the fetal or neonatal period with concomitant diagnoses of Congenital Diaphragmatic Hernia and spinal anomalies. All patients had normal karyotype analysis. Six of these patients had both defects diagnosed using prenatal ultrasonography. All patients died before hospital discharge. Although the numbers are limited in our series, patients with Congenital Diaphragmatic Hernia and spinal anomalies have a dismal prognosis. This finding has significant implications for prenatal counseling. III.

Ronald B. Hirschl - One of the best experts on this subject based on the ideXlab platform.

  • factors associated with survival in infants with Congenital Diaphragmatic Hernia requiring extracorporeal membrane oxygenation a report from the Congenital Diaphragmatic Hernia study group
    Journal of Pediatric Surgery, 2009
    Co-Authors: Rupa Seetharamaiah, John G Younger, Robert H Bartlett, Ronald B. Hirschl
    Abstract:

    Abstract Objective To identify factors associated with survival in patients with Congenital Diaphragmatic Hernia (CDH) treated with extracorporeal membrane oxygenation (ECMO). Methods We retrospectively analyzed the data on 3100 patients with CDH in the Congenital Diaphragmatic Hernia Study Group from 82 participating pediatric surgical centers (1995-2004). Covariates considered included prenatal and perinatal clinical information, specifics of surgical repair, and the duration of extracorporeal support. Result Nine hundred seven patients from the registry were identified as having been both managed with ECMO and undergone attempted surgical repair. The survival rate for the entire Congenital Diaphragmatic Hernia Study Group registry was 67% and 61% for those receiving ECMO in whom repair was attempted ( P P P P P Conclusion Our model identifies a group of pre-surgical and postsurgical parameters that predict survival rate in patients with CDH on ECMO support. This model was derived from the retrospective data from a large database and will need to be prospectively tested.

  • New Approaches to Managing Congenital Diaphragmatic Hernia
    Seminars in perinatology, 2004
    Co-Authors: Felicia A Ivascu, Ronald B. Hirschl
    Abstract:

    A number of new techniques have been studied for managing newborns with Congenital Diaphragmatic Hernia and respiratory insufficiency. Among these have been the techniques of delayed approach to the repair of the Diaphragmatic Hernia; permissive hypercapnia; nitric oxide and surfactant administration; intratracheal pulmonary ventilation; liquid ventilation; perfluorocarbon-induced lung growth; and lung transplantation. These interventions are at various stages of development and evaluation of effectiveness. All, however, are being explored in the hopes of improving outcome in patients with Congenital Diaphragmatic Hernia who continue to have significant morbidity and mortality in the newborn period.

Kevin P Lally - One of the best experts on this subject based on the ideXlab platform.

  • minimally invasive repair of Congenital Diaphragmatic Hernia
    Journal of Pediatric Surgery, 2011
    Co-Authors: Kuojen Tsao, Pamela A Lally, Kevin P Lally
    Abstract:

    Abstract Purpose Operative approach, including minimally invasive surgery (MIS) in the repair of Congenital Diaphragmatic Hernia (CDH), is variable among institutions. The short-term recurrent Hernia rate is not well described. We evaluated the in-hospital recurrence rate of MIS repairs of infants with CDH from the Congenital Diaphragmatic Hernia Registry. Methods Prospectively collected data from infants with CDH were analyzed from the Congenital Diaphragmatic Hernia Registry from January 1995 to January 2010. Recurrent Hernia was defined as reoperations during initial hospitalization. Operative approaches included abdominal, thoracic, laparoscopic, and thoracoscopic techniques. Results Five thousand four hundred eighty infants with CDH were identified, of which 4516 (82.4%) were repaired. Operative data were available in 4390 infants. One hundred fifty-one infants (3.4%) underwent MIS repairs with 12 reported recurrences (7.9%) compared with 114 for open techniques (2.7%, P Conclusion Minimally invasive techniques appear to have a significant higher recurrent Hernia rate, with thoracoscopy being the highest. Although adjusted for patch repair, other factors with regard to disease severity may contribute to differences in outcomes among centers. This study is limited to short-term recurrence during initial hospitalization.

  • postdischarge follow up of infants with Congenital Diaphragmatic Hernia
    Pediatrics, 2008
    Co-Authors: Kevin P Lally, William A Engle
    Abstract:

    Infants with Congenital Diaphragmatic Hernia often require intensive treatment after birth, have prolonged hospitalizations, and have other Congenital anomalies. After discharge from the hospital, they may have long-term sequelae such as respiratory insufficiency, gastroesophageal reflux, poor growth, neurodevelopmental delay, behavior problems, hearing loss, Hernia recurrence, and orthopedic deformities. Structured follow-up for these patients facilitates early recognition and treatment of these complications. In this report, follow-up of infants with Congenital Diaphragmatic Hernia is outlined.

  • Defect size determines survival in infants with Congenital Diaphragmatic Hernia.
    PEDIATRICS, 2007
    Co-Authors: Kevin P Lally, Pamela A Lally, Robert E. Lasky, Dick Tibboel, Tom Jaksic, Jay M. Wilson, Björn Frenckner, Carl Davis
    Abstract:

    OBJECTIVES Congenital Diaphragmatic Hernia is a significant cause of neonatal mortality. The objective of this study was to evaluate the clinical factors associated with death in infants with Congenital Diaphragmatic Hernia by using a large multicenter data set. METHODS This was a prospective cohort study of all liveborn infants with Congenital Diaphragmatic Hernia who were cared for at tertiary referral centers belonging to the Congenital Diaphragmatic Hernia Study Group between 1995 and 2004. Factors thought to influence death included birth weight, Apgar scores, size of defect, and associated anomalies. Survival to hospital discharge, duration of mechanical ventilation, and length of hospital stay were evaluated as end points. RESULTS A total of 51 centers in 8 countries contributed data on 3062 liveborn infants. The overall survival rate was 69%. Five hundred thirty-eight (18%) patients did not undergo an operation and died. The defect size was the most significant factor that affected outcome; infants with a near absence of the diaphragm had a survival rate of 57% compared with infants having a primary repair with a survival rate of 95%. Infants without agenesis but who required a patch for repair had a survival rate of 79% compared with primary repair. CONCLUSIONS The size of the Diaphragmatic defect seems to be the major factor influencing outcome in infants with Congenital Diaphragmatic Hernia. It is likely that the defect size is a surrogate marker for the degree of pulmonary hypoplasia. Future research efforts should be directed to accurately quantitate the degree of pulmonary hypoplasia or defect size antenatally. Experimental therapies can then be targeted to prospectively identify high-risk patients who are more likely to benefit.

  • Congenital Diaphragmatic Hernia.
    Current opinion in pediatrics, 2002
    Co-Authors: Kevin P Lally
    Abstract:

    Congenital Diaphragmatic Hernia occurs in approximately 1 in every 2500 live births and is associated with a reported mortality of almost 35% in live-born patients and a higher mortality when in utero deaths are counted. Ventilator-induced lung injury, pulmonary hypoplasia, and other associated anom