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English Journal

Contralateral Metachronous Hernia Following Negative Laparoscopic Evaluation for Contralateral Patent Processus Vaginalis: A Meta-analysis.

Zhong H1, Wang F.Author information 1Department of Pediatric Surgery, Ningbo Women and Children's Hospital , Ningbo, Zhejiang, China .AbstractAbstract Objective: To conduct a meta-analysis of contralateral metachronous inguinal hernia (CMIH) that originated from negative laparoscopic evaluation for contralateral patent processus vaginalis (CPPV) in children who presented with a unilateral inguinal hernia and to determine the incidence of and factors associated with such a CMIH. Materials and Methods: A PubMed search was performed for all studies concerning laparoscopic repair or evaluation of inguinal hernia in children. The search strategy was as follows: (laparoscop* OR coelioscop* OR peritoneoscop* OR laparoendoscop* OR minilaparoscop*) AND ("inguinal hernia" OR "metachronous hernia") AND child*. Inclusion criteria included unilateral inguinal hernia in children, negative laparoscopic evaluation of CPPV, without history of contralateral inguinal surgery previously, and clearly reporting CMIH development or not. Editorials, letters, review articles, case reports, animal studies, and duplicate patient series were excluded. Results: Twenty-three studies comprising 6091 children with negative CPPV fulfilled the inclusion criteria and were included in the final analysis, of whom 80 (1.31%) subsequently presented with a CMIH. Subgroup analysis showed that CMIH incidence was lower through an umbilical approach than via an inguinal one (0.85% versus 1.78%, P=.009). As for the transinguinal approach, there was a CMIH incidence of 0.78% and 2.05%, respectively, for laparoscopy with a small angle (30° and 70°), whereas there was no CMIH development for that with a large angle (110°, 120°, and flexible). A high pneumoperitoneum pressure (>10 mm Hg, >12 mm Hg, and >14 mm Hg) was usually associated with a slightly higher CMIH incidence than a low one (≤10 mm Hg, ≤12 mm Hg, and ≤14 mm Hg), all without significant difference. CMIH incidence was slightly lower for using a broad CPPV definition than for using a narrow one (0.64% versus 1.35%, P=.183). Conclusions: CMIH following negative laparoscopic evaluation for CPPV was a rare but possible phenomenon. Choosing the transumbilical approach, transinguinal laparoscopy with a large angle, low-pressure pneumoperitoneum, and broad CPPV definition would probably reduce the occurrence of such CMIHs.
Journal of laparoendoscopic & advanced surgical techniques. Part A.J Laparoendosc Adv Surg Tech A.2014 Feb;24(2):111-6. doi: 10.1089/lap.2013.0429. Epub 2013 Nov 1.
Abstract Objective: To conduct a meta-analysis of contralateral metachronous inguinal hernia (CMIH) that originated from negative laparoscopic evaluation for contralateral patent processus vaginalis (CPPV) in children who presented with a unilateral inguinal hernia and to determine the incidence of
PMID 24180355

Laparoscopic herniotomy in children: prospective assessment of tertiary center experience in a developing country.

Shehata SM1, El Attar AA, Attia MA, Hassan AM.Author information 1Department of Pediatric Surgery, Tanta University Hospital, 12th El-Motawakel Street, Flat No.1, Tanta El-Gidida, Tanta, 31111, Egypt. sherifshehata2001@yahoo.comAbstractPURPOSE: We aimed to assess prospectively the feasibility and outcome of laparoscopic herniotomy (LH) in children in a tertiary center with limited resources.
Hernia : the journal of hernias and abdominal wall surgery.Hernia.2013 Apr;17(2):229-34. doi: 10.1007/s10029-012-1031-1. Epub 2012 Dec 27.
PURPOSE: We aimed to assess prospectively the feasibility and outcome of laparoscopic herniotomy (LH) in children in a tertiary center with limited resources.METHODS: Fifty-six children with unilateral pediatric inguinal hernia (PIH) were treated for an 18-month period. All cases were subjected to L
PMID 23269403

Simple maneuvers to reduce the incidence of false-negative findings for contralateral patent processus vaginalis during laparoscopic hernia repair in children: a comparative study between 2 cohorts.

Tam YH1, Wong YS, Chan KW, Pang KK, Tsui SY, Mou JW, Sihoe JD, Lee KH.Author information 1Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, Prince of Wales Hospital, Shatin, NT, The Chinese University of Hong Kong, Hong Kong, China. pyhtam@surgery.cuhk.edu.hkAbstractBACKGROUND: Transumbilical or transinguinal laparoscopic evaluation for contralateral patent processus vaginalis (CPPV) is commonly performed during laparoscopic or open hernia repair in children but may occasionally give false-negative findings.
Journal of pediatric surgery.J Pediatr Surg.2013 Apr;48(4):826-9. doi: 10.1016/j.jpedsurg.2012.07.043.
BACKGROUND: Transumbilical or transinguinal laparoscopic evaluation for contralateral patent processus vaginalis (CPPV) is commonly performed during laparoscopic or open hernia repair in children but may occasionally give false-negative findings.METHODS: A retrospective study was conducted to compar
PMID 23583141

Japanese Journal

術前超音波対側検索による小児片側鼠径ヘルニア術後対側発症予防効果

秦信輔,奈良啓悟,野村元成,大島令子,前田栄,賀川義規
日本小児外科学会雑誌 44(5), 667-671, 2008-08-20
… patent processus vaginalis (CPPV))の検索およびCPPV陽性例における対側同時手術により小児片側鼠径ヘルニア術後の対側発症率が低下したか否か検討した.【対象と方法】1998年8月より2002年12月に経験した348例の片側鼠径ヘルニアのうち術前超音波検査にて74例(21.3%)がCPPV陽性と診断され両側手術を受けた.残る274例(男児128例,女児146例)のCPPV陰性である片側手術症例 …
NAID 110006863493

人工呼吸器の作動原理と作動様式Q&A (特集知らなきゃできない!人工呼吸器Q&A)

福家伸夫
月刊ナーシング 24(6), 34-41, 2004-05
NAID 40006172421

術後気管支瘻に対するHFJVを併用した左右肺独立換気法の経験

成田久仁夫,今泉宗久,上田裕一,岩波洋
日本呼吸器外科学会雑誌 17(7), 729-734, 2003-11-15
症例は58歳男性.突然の喀血を主訴に来院.緊急内視鏡検査により右B^1からの持続性出血を確認し,経内視鏡的止血操作及び気管支動脈塞栓術を行ったが止血出来ず,右上葉切除術を施行した.術後第2病日に気管支断端瘻の合併を確認したが,全身状態も不良であったことから再手術は施行せず,左片側肺のIPPVを開始した.しかし,広範な吸引性肺炎と右中下葉無気肺の発生により,呼吸状態は急速に悪化した.右無気肺の再膨張 …
NAID 110001270101

Related Pictures

Patent Processus Vaginalis (CPPV Program in Pharmacovigilance (CPPV WWE '13 EIW Armageddon CPPV Promo Poster Chariot de transport CPPV pour profilés Bachmann CPPV 200 K Prop. valve amplifier EIW Night Of Champions CPPV Promo Poster -Valve-Amplifier-CPPV-200-S-Used-54461

★リンクテーブル★

国試過去問	「112A041」「102G040」
リンク元	「人工呼吸」「持続的陽圧換気」
関連記事	「CP」「CPP」

「112A041」

　　[★]

55歳の女性。呼吸困難を主訴に来院した。1年前から左頸部の腫瘤を自覚していた。2か月前に呼吸困難が出現した。次第に増悪したため自宅近くの診療所を受診したところ、胸部エックス線写真で胸水を指摘され、左鼠径部にもリンパ節腫大を指摘されたため、紹介されて受診した。身長 151cm、体重 70kg。体温 36.8℃。脈拍 92/分、整。血圧 130/102mmHg。呼吸数 18/分。SpO2 94%(room air)。呼吸困難の原因は胸水貯留であると考え、入院の上、胸腔穿刺を行い胸水を排液した。呼吸困難は一時的に改善したが、穿刺1時間後に強い呼吸困難と泡沫状の喀痰がみられ、SpO2 92%(鼻カニューラ2L/分酸素投与下)となった。穿刺2時間後、症状はさらに悪化し、SpO2 85%(マスク8L/分酸素投与下)となったため気管挿管を行った。来院時と胸腔穿刺1時間後の胸部エックス線写真(別冊No. 17Ａ)と胸部CT(別冊No. 17Ｂ)とを別に示す。
この患者に最も有効な呼吸管理はどれか。

a　分離肺換気
b　持続的陽圧換気(CPPV)
c　非侵襲的陽圧換気(NPPV)
d　Tピースによる12L/分酸素投与
e　リザーバー付マスクによる10L/分酸素投与

[正答]

※国試ナビ4※　［112A040］←［国試_112］→［112A042］

「102G040」

　　[★]

自発呼吸を残さない人工呼吸はどれか。2つ選べ。

[正答]

※国試ナビ4※　［102G039］←［国試_102］→［102G041］

「人工呼吸」

　　[★]

英: artificial respiration, artificial ventilation

概念

1. 人工的に呼吸を行わせること。このため、伝統的なmouth to mouthからバックアンドバルブマスク、あるいは人工呼吸器を用いて行う。
2. 一次救命処置の中における処置　→　人工呼吸#一次救命処置

人工呼吸適応

SAN.422

肺活量 < 10ml/kg, PaO2 < 55 mmHg(50%以上の酸素投与下), 呼吸回数 > 35/min, 努力呼吸, 吸引圧 < -25cmH2O

人工呼吸のモード

送気制御パターンによる分類

量規定換気 volume controlled ventilation VCV
圧規定換気 [[]] PCV

換気モード

調節換気 controlled mechanical ventilation CMV

間欠的陽圧呼吸 IPPV：間欠的に定容量のガスを換気する
持続的陽圧呼吸 CPPV：間欠的に定容量のガスを換気する　＋　呼気終末陽圧の付加

同期型間欠的強制換気 synchronized intermittent mandatory ventilation SIMV = 間欠的強制換気 intermittent mandatory ventilation IMV：自発呼吸が不十分な場合に、陽圧呼吸が強制的に行われる。
圧支持換気 pressure suppot ventilation
持続気道内陽圧 continuous positive airway pressure CPAP：自発呼吸をしている患者に呼気・吸気を通じて陽圧を欠ける。
非侵襲的陽圧換気法 noninvasive positive pressure ventilation NPPV