Congenital brachial plexus exploration

Stanford's experience in the management of obstetrical brachial plexus palsy dates from 1983. A formal clinic service began in 1992. The tenets of management include early evaluations, a dependency on sequential evolution for decision-making, and very early neural surgery for babies with abnormal hands. We watch babies with normal hands for a longer time before advising surgery. At exploration, common patterns of injury are observed. Intraoperative evoked potentials are used to make surgical decisions. Reconstructive goals for upper plexus injuries include shoulder and elbow control. The paramount goal for babies with global palsies is hand function. Therapy throughout the child's growth years is vital. Sequelae, particularly shoulder contractures, require early surgical intervention. Secondary reconstructive procedures are typically beneficial in improving function. Since 1992, over 400 children have been examined, 62 have had neural reconstruction, and 102 have undergone secondary procedures. Surgery has been remarkably complication free. All children having neural reconstruction except 2 have been benefited.     

Motor impairment in normal aging,clinically possible Parkinson's disease,and clinically probable Parkinson's disease: longitudinal evaluation of a cohort of prospective brain donors

This study presents data on the antemortem evaluations of a cohort of individuals registered in a brain donation program. Clinical evaluation determined that many individuals were unaware they had clinical signs of Parkinson's disease (PD) (rest tremor, bradykinesia, rigidity). Quantitative motor testing (timed tapping test and Purdue pegboard test) revealed a graded reduction in performance in those clinically found to have clinically possible and clinically probable PD. Longitudinal examinations over 4 years revealed some individuals progressed from control to clinically possible PD and clinically possible PD to clinically probable PD. This study underscores the importance of longitudinal antemortem testing of prospective brain donors as well as the potential value of quantitative motor testing.     

Robotic hysterectomy: technique and initial outcomes

A surgical robot can move in ways that the human wrist cannot. Is it a practical substitute for the conventional hands-on approach?     

Analysis of a linear peristaltic infusion device for the transfusion of red cells to pediatric patients

A linear peristaltic infusion device was evaluated for red cell (RBC) transfusion in the pediatric and neonatal setting. CPDA-1 RBC units (n = 24) divided into six groups of 4 units each underwent simulated transfusion. Blood was infused by using manufacturer-provided administration sets with either a 21-gauge needle or a 24-gauge catheter. Filters were used in two groups to evaluate the effect of negative pressure on filter function. Two groups of RBCs less than 1 week old were washed, irradiated, and infused at 5 mL per hour, by using a standard administration set, or at 10 mL per hour, by using a syringe set. Four-week-old RBCs (washed and irradiated, irradiated and filtered, filtered only, or unmanipulated) were infused at 100 mL per hour. Paired samples from 0 and 2 hours before and after infusion were analyzed for hemoglobin, hematocrit, RBC count, plasma hemoglobin, lactate dehydrogenase, potassium, alanine aminotransferase, and aspartate aminotransferase. Hausser and Nageotte hemocytometers were used to perform white cell (WBC) counts when a filter was used. By analysis of variance and percentage of change, data from 0 and 2 hours before and after infusion were compared. No clinically or statistically significant differences were seen for hemoglobin, hematocrit, or RBC count. The difference in preinfusion and postinfusion plasma hemoglobin levels in washed RBCs at 2 hours was statistically but not clinically significant (14.5 +/− 6.8 vs. 19.3 +/− 7.1 mg/dL). No clinically significant differences were noted for the remaining analytes.(ABSTRACT TRUNCATED AT 250 WORDS)     

Injury to the dorsal sensory branch of the ulnar nerve in the arthroscopic repair of ulnar-sided triangular fibrocartilage tears using an inside-out technique: a cadaver study

This anatomic study of the commonly described inside-out Tuohy needle technique was performed to better define the course of needle passage relative to the anatomic structures in this region including the dorsal sensory branch of the ulnar nerve (DBUN) and extensor carpi ulnaris (ECU) tendon. Ten fresh-frozen cadaver specimens had arthroscopic-guided passage of a Tuohy needle through the triangular fibrocartilage (TFC). Dissection of the ulnar side of the wrist was performed and various measurements were recorded. The average minimum distance between suture A (the suture closest to the nerve) and the DBUN was 1.9 mm. The average minimum distance between suture B and the DBUN was 2.7 mm. The distance between the 2 sutures at the level of the capsule averaged 6.2 mm. The distance between the DBUN and the ECU averaged 7.2 mm. In 5 of 10 specimens the sutures exited on opposite sides of the DBUN. The DBUN is variable in its course but in every case it passes in close proximity to the sutures that exit the ulnar side of the wrist in arthroscopic repair of ulnar-sided TFC tears.     

Primary Percutaneous Treatment of Transplant Ureteral Strictures Using Tandem Stents

PurposeTo evaluate outcomes of primary (first-occurrence) treatment of renal transplant ureteral strictures using tandem parallel internal double-pigtail stents.Materials and MethodsA retrospective electronic chart review, including demographics, medical history, stricture intervention, and outcomes, was performed of patients with renal transplants with first-occurrence ureteral obstructions or leaks reported in a transplant nephrology database over a 4-year period, with a focus on patients treated primarily with tandem stents.ResultsOf 27 patients with first-occurrence ureteral obstruction or ureteral leak, 18 (67%) were treated primarily using tandem internal stents, with 15 (83%) of 18 stent-free for a minimum 90 days of follow-up. There was no significant difference between outcomes for male versus female patients (P>.99) or early versus late strictures (P = .53). Urinary tract infections (UTIs) occurred in 14 (78%) of 18 patients with tandem stents in place. Four patients were hospitalized<48 hours with UTI and sepsis; there were no other major complications.ConclusionsPatients with renal transplants can be successfully managed nonsurgically using tandem ureteral stents for the primary treatment of first-occurrence ureteral stricture. These patients may require more intensive monitoring for UTIs.