title: Long-term effect of bilateral plication of the diaphragm.
abstract: OBJECTIVE
  To assess the feasibility and clinical outcome of bilateral plication of the diaphragm in patients with bilateral diaphragmatic paralysis (BDP) caused by neuralgic amyotrophy (NA), a mononeuritis of the phrenic nerves.
  
  
  METHODS
  Prospective, case-control study over a 1-year period.
  
  
  METHODS
  A university hospital in The Netherlands.
  
  
  METHODS
  Six patients who presented with BDP caused by NA.
  
  
  METHODS
  The diagnosis of BDP was based on the absence of muscle response after cervical magnetic stimulation of both phrenic nerves. Three patients did not undergo surgery but were observed for a period of 2 years, and the other three patients underwent a limited lateral thoracotomy at the eighth intercostal space. Plication was performed by U-stitches until the diaphragm was as tight as possible. Vital capacity (VC) and arterial blood gas was measured during follow-up.
  
  
  RESULTS
  One month postoperatively, mean VC measured in the supine position was significantly improved by 17%, and this effect was sustained for 12 months. Arterial PO(2) increased by 45%. VC and blood gas levels did not improve in the three patients that were only observed during the 2-year period. All three surgical patients could sleep in the supine position after the operation.
  
  
  CONCLUSIONS
  Bilateral plication of the diaphragm for NA-induced paralysis results in improvement of ventilation and blood gas exchange, allowing patients to sleep in the supine position without dyspnea.
authors.affiliation: Departments of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands. jstolk@pulmonology.azl.nl
authors.forename: J
authors.initials: J
authors.lastname: Stolk
authors.forename: M I
authors.initials: MI
authors.lastname: Versteegh
mesh_terms: D000368:Aged; D020968:Brachial Plexus Neuritis / Q000601:surgery*; D002245:Carbon Dioxide / Q000097:blood; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D010791:Phrenic Nerve; D011183:Postoperative Complications / Q000209:etiology* / Q000503:physiopathology; D011446:Prospective Studies; D011659:Pulmonary Gas Exchange / Q000502:physiology; D012133:Respiratory Paralysis / Q000601:surgery*; D013536:Suture Techniques; D014797:Vital Capacity / Q000502:physiology
chemical_list: D002245:Carbon Dioxide; D010100:Oxygen