Herpes zoster generally affects sensory nerves, but occasionally motor nerves also are affected,'2 so that flaccid muscle paresis develops in the segments corresponding to the dermatomes in which cutaneous lesions appear. The site of the lesion in the motor neurone is not clear, but the absence of electromyographic fasciculations and slow motor conduction velocity point to motor axon damage. Postherpetic paresis of the diaphragm has been reported in rare instances.34 In the present case it developed on the left side after ipsilateral cervical herpes zoster, with the electromyographic signs of neurogenic paresis of other muscles in the same segments. Hemidiaphragmatic paresis after cervical herpes zoster in a man with chronic bronchitis and emphysema: (a) first low position ofthe diaphragm due to emphysema, followed by (b) left-sided paresis (September 1980). Two straight lines, tangential to the highest point ofeither dome and perpendicular to the axis ofthe spine, determine the difference in level.5 870 on 12 May 2018 by guest. Protected by copyright.
In 24 subjects with pectus excavatum we evaluated whether the previously detected unfavourable effects of corrective surgery on the ventilatory capacity were attributable to pulmonary or to chest wall factors. We found that 12.2 +/- 3.7 yrs postoperatively (i.e. at the age of 23.3 +/- 5.4 yrs) the vital capacity was decreased from 89 +/- 10% predicted (pred) preoperatively to 64 +/- 6% pred (p less than 0.001) and forced expiratory volume in one second from 88 +/- 17 to 66 +/- 11% pred (p less than 0.001). At total lung capacity (TLC; 69 +/- 5% pred) we found an obvious reduction in transpulmonary pressure (59 +/- 23% pred) and in transdiaphragmatic pressure (30 +/- 17 cmH2O) postoperatively. This indicated an extrapulmonary cause of the restrictive defect, attributable to abnormal chest wall mechanics secondary to the extensive surgery on the sternum and parasternal zones.
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