Congenital diaphragmatic hernia

Peritoneopericardial diaphragmatic hernia in a catCongenital Diaphragmatic Hernia (CDH) is a congenital abnormality that is often life-threatening because it can limit the growth of the lungs. The site of herniation is most commonly found on the left side in the hole originally designed for the entry of alimentary canal. Herniation is sometimes found near sternum.


Defects
It involves three major defects.

A failure of the diaphragm to completely close during development.
Herniation of the abdominal contents into the chest
Pulmonary Hypoplasia

Early diagnosis and presentation
This condition can often be diagnosed before birth and fetal intervention can sometimes help, depending on the severity of the condition.[1] Infants born with diaphragmatic hernia experience respiratory failure due to both pulmonary hypertension and pulmonary hypoplasia. The first condition is a restriction of blood flow through the lungs thought to be caused by defects in the lung. Pulmonary hypoplasia or decreased lung volume is directly related to the abdominal organs presence in the chest cavity which causes the lungs to be severely undersized, especially on the side of the hernia.

Survival rates for infants with this condition vary, but have generally been increasing through advances in neonatal medicine. Work has been done to correlate survival rates to ultrasound measurements of the lung volume as compared to the baby's head circumfrence. This figure known as the lung to head ratio (LHR) may be used to determine if fetal surgery may be used 

Renal failure (腎衰竭)

The doctors are performing kidney transplantation by endoscopy.

Renal failure are classified into chronic and acute. Chronic renal failure is irreversible (over 75% of kidney cells are damaged). It is caused by vascular diseases, obstruction of urine outflow, recurrent infection of kidney and hypersensitive reaction.

Renal failure causes various problem like
1. waste production retention:
- As glomerulus filtration is decreased, less urea is excreted. Thus more urea is retented in blood. High concentration of urea then leads to high concentration of urea in glomerulus filtration. As urea is osmotic reactive, more water is drawn into the renal tubules which may cause hypotension.
- At the same time, K+ excretion is not enough. High concentration of potassium depresses nervous system causing muscle weekness and fatigue
- Retention of PO4= causing inhibition of enzyme for activating vitamin-D which in turn lowers the Calcium absorption in the gut. Bone pain and weakness occur.

2. Inability to control the osmolarity of extracellular volume (inability to control Na+)
-polyurea
-isothenmia
-nocturia (urination at night)

3. Inability to control blood pressure
when sodium intake is more than our bodies require, hypertension occurs.
When sodium intake is insufficient, hypotension occurs.

4. Effect on blood components
uremia affects platelet functions which leads to defective clotting
decrease in erythropoietin production and thus lowers the red blood cells count leading to anaemia

5. Loss of useful substacnce
NaCl, glucose, proteins, HCO3- due to inadequate reabsortion

6. Loss of HCO3-
H2CO3- acts as a buffer in our bodies, insufficient reabsortion casues metabolic acidosis.
Respiratory compensation is acticated to eliminate CO2 in blood.

7. Compensatory hypertrophy

Treatments:
dialysis, kidney transplant, antibiotics for infection, removal of obstruction, sodium bicarbonate intake for acidosis, blood transfusion for anaemia

Acute renal failure is reversible. (urine out is inadequate to eliminate waste product in body, <0.5L/day) 

Prostate cancer

Prostate gland cancer is a common cancer in male. The symptoms are difficulty in urination, painful urination, decrease in urine ouput and increased frequency of urination. Prostate gland hypertrophy has similar symptoms as prastate cancer. To differentiate, testing the level of P.S.A. (前列腺特異抗原) can help. Patient who has cancer has higher level of P.S.A. while those have hypertrophy have only a little elevation.