A combined sternotomy/laparotomy approach in central tendon diaphragmatic hernia repair
Bibliographic record
Abstract
We describe a combined sternotomy/laparotomy approach as a novel technique in central tendon diaphragmatic hernia repair. During a routine second trimester prenatal ultrasound, a 19-year-old woman was found to have a fetus with a diaphragmatic hernia. Subsequent fetal MRI at 28 weeks demonstrated a large central tendon defect through which the majority of the liver was herniated. The fetus was closely followed until her delivery at 38 weeks. The patient was intubated shortly after delivery and treated for pulmonary hypertension. A thoraco-abdominal CT scan revealed a large, mushroom-shaped herniation of the liver. By day of life 7, the patient demonstrated physiological stability. Following a multidisciplinary meeting, the decision was made to proceed to surgery. A sternotomy with an upper midline laparotomy revealed the liver herniating through a central tendon defect without any hernia sac. The liver was reduced into the abdomen without kinks in the hepatic veins. The defect was then closed using a polytetrafluoroethylene patch. She did not develop any compartment syndrome despite pre-operative concerns. Post-operatively, she was weaned to conventional mechanical ventilation after brief requirement of high-frequency oscillatory ventilation, and subsequently extubated. A combined sternotomy/laparotomy provided an excellent operative exposure and may be effective in a large congenital central tendon diaphragmatic hernia repair.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".