[On the problem of the course of certain mental disorders in infants after birth injury].
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Over a 5-year-period, 26 infants underwent a partial transfer of the spinal accessory nerve into the suprascapular nerve using a nerve graft, as part of the repair of a brachial plexus birth injury. At a minimum follow-up of 2.5 years, all children had shoulder function of Grade 4 or better using a modified Gilbert Scale. Average lateral rotation was measured at 53 degrees.
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A 26-year-old female, the elder of monozygotic twins, presented with slow progressive numbness and pain in her left arm. Magnetic resonance (MR) imaging showed syringomyelia with Chiari malformation. The patient's birth had been difficult with prolonged delivery time, breech delivery, and neonatal asphyxia. MR imaging of the patient's twin sister showed mild tonsillar ectopia, but absence of syringomyelia. This younger sister was born without problems. The patient underwent syringosubarachnoid shunt at the C5-6 level. The syrinx was collapsed promptly, and her symptoms disappeared. This case of syringomyelia with Chiari malformation in one of twins suggests that birth injury is likely to be a cause of the pathogenesis of syringomyelia.
From 1980 to 1994, a total of 73 patients were treated at the Russian Research Surgery Institute named after A. L. Polenov for damage to the brachial plexus during birth injury. The authors proposed an original procedure for treating these patients. This involved conservative therapy, surgical intervention on the brachial plexus and correction of the arm locomotor apparatus by orthopedic techniques. The conservative treatment were performed by original methods: namely in combination with hyperbaric oxygenation, low-energy laser exposure of the brachial plexus or by administering cholinesterase agents into the bioenergetic points, followed by electrostimulation of the neuromuscular apparatus. The original conservative treatment led to a significantly improved arm function in 53% of the patients. If the conservative therapy failed, obstacles to the restoring the conduction of the brachial plexus were eliminated via operations (neurolysis, suture, autoplasty, reinnervation). The operation gave the benefit to 74% in whom conservative therapy turned out to be ineffective. If surgical recovery of the brachial plexus failed, arm locomotor intervention was applied.
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The epidemiology of syringomyelia with Chiari type I deformity was investigated with particular reference to perinatal problems. All subjects in our study were born by vaginal delivery and had a high incidence of perinatal accidents (abnormal presentations, birth injuries, and neonatal asphyxia). This study suggests that these may be strong causative factors for syringomyelia associated with Chiari type I deformity.
A four year old cow with an enlargement of the uterus of unknown cause was submitted to the clinic. The cow had a pyonecrotizing myometritis and placental retention following an injury of the birth canal. The final diagnosis was only made after pathological examination.
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