The results of a series of distal brachial plexus target reinnervations with long grafts is presented and analyzed. According to them, time from trauma to surgery and an adequate postoperative rehabilitation are important predictors of outcome.

We have designed and tested a simple and reliable method by which to quantify neuropathic pain after traumatic brachial plexus injuries. Initial surgical treatment of the paralysis--including nerve, trunk and root reconstruction, and neurolysis--comprises an effective means by which to initially treat neuropathic pain. Ablative or neuromodulative procedures, like dorsal root entry zone, should be reserved for refractory cases.

Purposeto compare two populations of brachial plexus palsies, one neonatal (NBPP) and the other traumatic (NNBPP) who underwent different nerve transfers, using the Plasticity Grading Scale (PGS) for detecting differences in brain plasticity between both groups. MethodsTo be included, all patients had to have undergone a nerve transfer as the unique procedure to recover one lost function. The primary outcome was the PGS score. We also assessed patient compliance to rehabilitation using the Rehabilitation Quality Scale (RQS). Statistical analysis of all variables was performed. A p ≤ 0.050 set as criterion for statistical signi cance. Resultsa total of 153 NNBPP patients and 35 NBPP babies (with 38 nerve transfers) met the inclusion criteria.The mean age at surgery of the NBPP group was 9 months (SD 5.42, range 4 to 23 months. The mean age of NNBPP patients was 22 years (SD 12 years, range 3 to 69). They were operated around sixth months after the trauma. All transfers performed in NBPP patients had a maximum PGS score of 4. This was not the case for the NNBPP population, that reached a PGS score of 4 in approximately 20% of the cases. This difference was statistically signi cant (p < 0.001). The RQS was not signi cantly different between groups ConclusionWe found that babies with NBPP have a signi cantly greater capacity for plastic rewiring than adults with NNBPP. The brain in the very young patient can process the changes induced by the peripheral nerve transfer better than in adults.

The study demonstrates that, in May 1987, testing urine for drugs of abuse can be accurate. All laboratories challenged in this study currently perform such testing under contract and are involved in monthly proficiency testing and in-service training (AACC's Surveys Plus and In-Service Training Program in Toxicology). The laboratories were challenged to detect drugs at the concentrations at which they accept business. We suspect that when results of studies of this kind have been reported previously, the laboratories may have been scored inaccurately because they used technology designed to detect higher concentrations of the drugs than were weighed into the study specimens. This points up the need for laboratories and clients to be specific about the threshold concentrations used to report positives and policies for reporting positives detected below those concentrations.