Gloria D. Eng

Obstetrical brachial plexus palsy (OBPP) outcome with conservative management

Resurgence of neurosurgical intervention of obstetrical brachial plexus palsy prompted our review of 186 patients evaluated between 1981 and 1993, correlating clinical examination, electrodiagnosis, and functional outcome with conservative management. Eighty‐eight percent had upper brachial plexus palsies, and 63% were mild. Forty‐two infants required no long‐term follow‐up because they rated 1 or 2 on initial physical examination. Comparing first and last follow‐up clinical findings of the remaining 149 patients, there was high agreement (correlation r = 0.81; P < 0.001). Pearson correlation of initial physical exam with electrodiagnosis at three intervals was relatively stable (r = 0.87, 0.88, 0.69). One hundred eight (72%) of the patients remained in their original severity groups. Thirty‐three of 41 patients with discrepant follow‐up scores improved by at least one category. Eight patients deteriorated. The natural pathophysiology and recovery of OBPP is presented.

The Prune Belly Syndrome: A Comprehensive Approach to Management *

Our approach to management of the prune belly syndrome entails a program of comprehensive early reconstruction, including abdominoplasty, bilateral orchiopexy, reduction cystoplasty, and selective ureteral tailoring and reimplantation. Of 20 patients with the prune belly syndrome treated at our institution during the last 18 years 15 underwent comprehensive reconstruction. Abdominoplasty was performed in 16 patients. Results were evaluated as to cosmetic appearance, functional performance, and preoperative and postoperative electromyography. Immediate good results were obtained in 9 patients. Of 16 patients 6 required more than 1 abdominal wall tailoring and 3 had minor complications that did not compromise the ultimate result. Transabdominal orchiopexy was performed on 32 testes; 28 (88 per cent) are in the scrotum and growing. Of the 4 failures 3 occurred in patients greater than 2 years old at repair. Selective urinary tract reconstruction has been performed; 13 patients underwent tapering and reimplantation of 1 or both ureters. Reduction cystoplasty was done in all 15 patients. Functional assessment of the upper urinary tract by improved radiological techniques and the necessity for long-term antibiotic prophylaxis have led to a more conservative approach in 5 recent patients. Renal function as measured by serum creatinine and/or glomerular filtration rate has remained stable in 12 of 15 patients (92 per cent) undergoing comprehensive reconstruction. Aggressive surgical management of patients with the prune belly syndrome provides improved abdominal wall function and appearance, and offers excellent testicular salvage. Surgical reconstruction of deformed ureters should be selective and decided on longitudinal studies of renal function.

Rehabilitation management of children with spastic diplegic cerebral palsy.

Spastic diplegia has been recognized as the type of cerebral palsy most frequently associated with prematurity. Due to constantly improving neonatal care in developed countries, more and smaller premature infants are surviving, and the number of spastic diplegic children can be expected to increase. This paper reviews the incidence, pathophysiology, and associated handicaps of patients with this type of cerebral palsy. The role of the physiatrist and aspects of traditional management are discussed. Recent advances in treatment of spasticity and lower extremity bracing are stressed as they seem to be particularly suitable to spastic diplegic patients.

Abdominal wall reconstruction in the prune belly syndrome

In our institution, 12 patients have been encountered with prune belly syndrome. Eight children have undergone evaluation of their abdominal musculature by electromyography. Results of their studies show that major functioning or recoverable muscle exists in the lateral and upper sector of the abdomen, but that little or no muscle exists in the lower central abdomen. Based in part on these findings, an operation has been devised which spares all potentially functioning musculature and corresponding motor nerves, and disposes of nonfunctioning and nonrecoverable muscle. In terms of cosmetic appearance and gross motor testing, these growing boys show significant improvement.

Surgical correction and rehabilitation for children with "Prune-belly" syndrome.

Until the recent past, patients born with congenital absence of the abdominal musculature, and associated deformity of the urinary collecting system, have often had an unhappy life and an early death. Twelve years ago, a treatment protocol was devised in our institution which included the following major steps: 1) bilateral tubeless pyelostomy immediately after birth;2) serial evaluation of renal status during the first year of life;3) laparotomy at one year of age with orchiopexy, reconstruction of the urinary collecting system and reconstruction of the abdominal wall; 4) serial electromyographic evaluation of tiie growth and development of the lateral abdominal musculature; 5) serial studies of renal function; 6) secondary revision of the abdominal wall and of the urinary drainage system as needed. Nine patients so treated have been followed from the third through the twelfth years of life. All are alive and growing well. One patient with no renal function died in the first month of life. Four patients have had chronic urinary infection treated with long-term antibiotics; three of these have required a second surgical correction of some aspect of the urinary drainage system. Three patients have required additional surgery on the abdominal wall, but have recaptured enough function so that corsets and other devices have not been necessary. Electromyographic studies show good growth and development of some aspects of the lateral abdominal musculature which has been used in the repair. The outcome in these patients is highly encouraging for this constellation of anomalies. The cause remains controversial.