In follow-up examinations of young patients we often noticed upward displacement of the left shoulder in cases where left-sided posterolateral thoracotomy had been carried out. Finding little discussion of this side-effect in the literature, we undertook the present study. The shoulder girdle of 69 patients who had undergone surgery for coarctation of the aorta between 1964 and 1984 was carefully examined to assess displacements and dysfunctions. In addition, in 24 of the patients electrodiagnostic examination was carried out of the associated muscles and nerves which were affected by the operation. We found disturbances of the muscular apparatus of the shoulder girdle in 80% of the cases: upward displacement of the shoulder (55%), downward displacement of the shoulder (8.7%), deviation of the scapula at rest (72.5%) and maximal elevated arms (40.6%), scapula alata (56.5%), and alterations of the posterior axillary line (39.1%). When considering only the cases of distinct upward or downward displacement of the shoulder, at least 25% of the operated children were affected. Children operated early (surgery during the first year of life) had more distinct alterations (47.6%) than those with later surgery (14.6%). Electromyographic examinations indicate that mainly disorders of the peripheral nerves caused by the operation led to these alterations of the shoulder girdle musculature. Although, except for one patient, no functional disorders were found, there were several cases in which the alteration caused quite severe cosmetic problems. One should pay more attention to positioning for surgery and do careful preparation to reduce these sequelae.
The infusion of streptokinase was the only probable cause found to explain the neuralgic amyotrophy, a connection that has never been reported until now.
550 patients suffering from Bell's palsy and examined by electromyography (EMG) as well as electroneurography (ENG) were interviewed in respect of treatment and remission. In more than 80% of the cases it was possible to register volitional activity by EMG as well as to elicit an electroneurographic response. We found a high correlation between electrodiagnostical deficit and degree of recovery. EMG and ENG were equally suitable to assess the severity of damage. The overall prognosis of Bell's palsy was favorable in cases of incomplete lesions. The recovery was probably improved by administration of steroids in the examined group, especially in cases with temporary loss of electroneurographic response.
In 64 patients with confirmed subarachnoid haemorrhage the clinical grading according to Hunt and Hess was compared to the initial findings of BAEP und SEP to elicit possible prognostic statements. Clinical and electrodiagnostic findings showed a high correlation. Patients without or with only slight alterations of amplitude and/or latency generally showed a favourable course. Recurrent haemorrhages or internal complications which can be decisive for outcome cannot be predicted by clinical or electrodiagnostic findings. The alterations of BAEP and SEP increase parallel to severity of clinical findings. Bilateral loss of BAEP or SEP indicates poor prognosis. Prognostic statements can be made with certainty only in cases with primary poor clinical condition (Hunt-Hess Grade IV-V) and marked alterations of evoked potentials.
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