The diaphragm:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
1998
|
| Schriftenreihe: | Chest surgery clinics of North America
8,2 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | IX, 477 S. Ill., graph. Darst. |
Internformat
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Datensatz im Suchindex
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| adam_text | THE DIAPHRAGM
CONTENTS
Preface xi
Darroch Moores
The Diaphragm and Respiratory Muscles 207
Bartolome Celli
This article describes the functional anatomy of the muscles that
contribute to the generation of ventilatory pressures. The physio¬
logic principles that guide their function are analyzed, and their
composition and metabolism are described, inasmuch as this af¬
fects their adaptation and capacity to face acute and chronic
loads. Special emphasis is placed on the clinical and laboratory
evaluation of their function. In addition, the concept of respira¬
tory muscle fatigue is developed so the reader can place all these
concepts in the context of their clinical applications.
Assessment of Diaphragm Function 225
Ellen B. Pacia and Thomas K. Aldrich
Assessment of diaphragm function begins with the physical ex¬
amination, but neither the physical examination nor radiography
is sensitive enough to detect subtle abnormalities of diaphragm
function. Maximal static transdiaphragmatic pressure and maxi¬
mal static inspiratory mouth pressure have been widely used as
measures of diaphragm and inspiratory muscle strength, respec¬
tively. Both are useful as rough indications of muscle strength,
but, because they are highly effort dependent, they should not be
relied upon for absolute accuracy. Objective measurement of
diaphragm function requires phrenic nerve stimulation.
CHEST SURGERY CLINICS OF NORTH AMERICA
VOLUME 8 • NUMBER 2 • MAY 1998 V
Imaging Evaluation of the Diaphragm 237
David S. Gierada, Richard M. Slone,
and Matthew J. Fleishman
Structural disorders of the diaphragm often produce abnormali¬
ties on chest radiographs, but may require cross sectional imaging
with computed tomography or magnetic resonance imaging for
detection or definitive characterization. Radiologic assessment of
diaphragm motion is valuable in the evaluation of diaphragm
dysfunction. This article reviews the normal and abnormal radio
logic findings related to the diaphragm, and illustrates the use of
the various imaging methods currently available.
Surgical Anatomy of the Diaphragm and the
Phrenic Nerve 281
Stanley C. Fell
In this article, the anatomy of the diaphragm and phrenic nerves
is discussed, together with related surgical implications. Since the
major cause of phrenic nerve injury is surgery, usually for congen¬
ital or acquired heart disease, incisions in the diaphragm that do
not injure major branches of the phrenic nerve are also discussed.
Diaphragmatic plication is usually required in infants less than 3
months of age, and older children may be managed by ventilatory
support if electrophysiologic studies document the possibility of
return of nerve function. In adults with normal pulmonary func¬
tion, unilateral diaphragmatic paralysis is usually asymptomatic.
Congenital Diaphragmatic Hernia 295
Jacob C. Langer
Congenital diaphragmatic hernia (CDH) is a developmental ab¬
normality resulting in a diaphragmatic defect that permits ab¬
dominal viscera to enter the chest. The mortality of CDH remains
high, despite a large number of innovations, including delayed
surgical repair, pharmacologic treatment of pulmonary hyperten¬
sion, novel ventilatory techniques, ECMO, and surfactant therapy.
New, and as yet unproven, modalities such as permissive hyper
capnia, fetal surgery, and liquid ventilation may provide greater
hope in the future for severely affected infants. Although most
surviving children with CDH do well, a significant incidence of
gastrointestinal and neurologic morbidity still exists.
Eventration of the Diaphragm 315
Jean Deslauriers
Eventration of the diaphragm is a condition where the muscle is
permanently elevated, but retains its continuity and attachments
to the costal margin. It is rare, seldom symptomatic, and often
requires no treatment. In symptomatic patients, plication of the
diaphragm may offer relief of the symptoms.
vi CONTENTS
Diaphragm Pacing 331
John A. Elefteriades and Jacquelyn A. Quin
Diaphragm pacing is an established mode of ventilation for pa¬
tients with upper motor neuron injury and preserved phrenic
nerve function. Careful patient evaluation with regard to phrenic
nerve function, motivation, and adequate psychosocial support is
paramount for successful pacing. In properly selected individuals,
full time continuous bilateral pacing for several years has been
demonstrated with advantages of increased independence and
productivity, fewer tracheal tube complications, and improved
phonation. Ongoing research in the field of diaphragm pacing
includes refinements in electrode placement and continued test¬
ing of totally implantable devices.
Adult Presentation of Unusual Diaphragmatic Hernias 359
Keith S. Naunheim
The vast majority of diaphragmatic hernias occurring in adults
are either standard hiatal hernias or those presenting acutely due
to traumatic disruption of the diaphragm. The remaining small
fraction represent unusual cases such as congenital hernias (Mor
gagni or Bochdalek) presenting in adulthood or traumatic hernias
presenting months to years after the traumatic (or surgical) event.
The recognition and management of these rare cases are dis¬
cussed.
Acute Traumatic Injury of the Diaphragm 371
Carl Rosati
Acute diaphragmatic injury resulting from penetrating or blunt
trauma represents a challenging clinical entity. Preoperative diag¬
nosis remains difficult in 50% to 70% of patients, and a timely
diagnosis requires a high index of suspicion. Once recognized,
the usual aspects of surgical repair are straightforward, such as
single layer repair using heavy non absorbable suture via the
transabdominal approach. However, complex injuries such as par
ahiatal defects, defects involving the diaphragmatic pericardium,
diaphragmatic avulsion, and injuries with massive tissue loss can
test the surgeon s skill and creativity. Prioritization of manage¬
ment in patients with multiple significant traumatic injuries de¬
mands a well organized approach with availability of highly spe¬
cialized resources and a well coordinated trauma and critical
care team.
The Diaphragm in Emphysema 381
Marc Ruel, Jean Deslauriers, and Francois Maltais
The diaphragm is the most important muscle involved in normal
breathing. Its physiology and pathophysiology have been studied
more extensively than that of any other respiratory muscle, and
CONTENTS vii
a thorough understanding of its structural and functional alter¬
ations in pulmonary emphysema has become important to tho¬
racic surgeons as surgical management of this disorder evolves
rapidly. This article reviews current concepts of diaphragmatic
pathophysiology in emphysema, with a perspective on surgical
modalities used in the management of this condition.
Hiatus Hernia: The Condition 401
Riivo lives
Hiatal hernia is a common condition. Many patients are asymp¬
tomatic or experience symptoms of gastroesophageal reflux.
However, with larger hernias, the hernia and its incarceration are
the issues, and most patients with this condition need surgical
attention.
Open Repair of Hiatus Hernia: Abdominal Approach 411
Darroch Moores and Lucius D. Hill
Open hiatus hernia repair can be accomplished with very low
mortality and excellent long term results. The vast majority of
hiatus hernias, including those with peptic stricture, can be re¬
paired transabdominally. The Hill repair, the Nissen, and the
Collis Nissen are well established techniques for repairing a hia¬
tus hernia that have stood the test of time and are associated
with good long term results. The technical aspects of these repairs
are discussed in detail within this article.
Open Repair of Hiatus Hernia: Thoracic Approach 431
Mark S. Allen
Open repair of a hiatal hernia remains an excellent method for
correction of symptomatic gastroesphageal reflux. This article
gives a technical description of the performance of the Belsey
Mark IV hiatal herniorrhaphy and the uncut Collis Nissen repair.
A brief description of preoperative evaluation and results is also
included.
Tumors of the Diaphragm 441
Benny Weksler and Robert J. Ginsberg
Primary tumors of the diaphragm are rare, and more than half
are benign. Diaphragmatic tumors arise from mesenchymal tissue
because of their mesodermal origin, and all varieties of these
tumors have been reported. An interesting paraphenomenon is
hypertrophic osteoarthropathy, most commonly seen in tumors
of neurogenic origin. In most instances, these tumors are small
and can be excised with a primary repair anticipated. Secondary
involvement of the diaphragm from lung cancer is more common,
but is rarely associated with a resectable lesion. Direct extension
from other intra abdominal or intrathoracic tumors can occur,
Viii CONTENTS
commonly from mesothelioma, lung cancer, and hepatic carci¬
noma. In some cases, en bloc excision of the diaphragm is re¬
quired, and in many instances diaphragmatic replacement is nec¬
essary using a variety of thin plastic prostheses, if a wide
resection is required. Attempts at primary repair under tension,
especially on the left side, may lead to diaphragmatic rupture
and herniation.
Porous Diaphragm Syndromes 449
Paul A. Kirschner
Porous diaphragm syndromes are a group of seemingly disparate
clinical symptom complexes involving a wide variety of unrelated
medical specialties. However, they are linked by a common ana¬
tomical feature, a defect in the diaphragm. They usually present
with thoracic symptomatology—pleural effusions, pneumotho
rax, hemothorax, empyema—mediated by this defect. Manage¬
ment of these syndromes utilizes principles of thoracic surgical
practice including thoracotomy and thoracoscopy.
Index 473
Subscription Information Inside back cover
CONTENTS ix
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| spellingShingle | The diaphragm Chest surgery clinics of North America Diaphragme Chirurgie (DE-588)4009987-8 gnd Komplikation (DE-588)4123547-2 gnd Zwerchfellkrankheit (DE-588)4127333-3 gnd Perioperative Phase (DE-588)4173783-0 gnd |
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| title | The diaphragm |
| title_auth | The diaphragm |
| title_exact_search | The diaphragm |
| title_full | The diaphragm Darroch Moores |
| title_fullStr | The diaphragm Darroch Moores |
| title_full_unstemmed | The diaphragm Darroch Moores |
| title_short | The diaphragm |
| title_sort | the diaphragm |
| topic | Diaphragme Chirurgie (DE-588)4009987-8 gnd Komplikation (DE-588)4123547-2 gnd Zwerchfellkrankheit (DE-588)4127333-3 gnd Perioperative Phase (DE-588)4173783-0 gnd |
| topic_facet | Diaphragme Chirurgie Komplikation Zwerchfellkrankheit Perioperative Phase Aufsatzsammlung |
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