[Abdominal wall paresis as a complication of herpes zoster]. / Buikwandparese als complicatie van herpes zoster.

BACKGROUND: Herpes zoster is an illness which is especially common amongst the elderly in the Netherlands and which can express itself in various ways. Besides affecting sensory nerves, which leads to postherpetic pain, the varicella zoster virus may also invade motor nerves. CASE DESCRIPTION: A 73-year-old female went to the surgeon with symptoms of a painful swelling in the left lower abdomen. She had experienced herpes zoster at the site of the swelling a few months earlier. A CT scan revealed asymmetry of the abdominal wall musculature, which led us to suspect a link between motor involvement of herpes zoster and the abdominal swelling. EMG revealed denervation of the affected abdominal wall muscle, which confirmed the link with herpes zoster in that dermatome. CONCLUSION: Abdominal wall paresis caused by herpes zoster is a rare condition. It can be diagnosed on the basis of clinical findings and may be confirmed by EMG investigation of the affected muscle. In view of the temporary nature of the paresis, it is possible to opt for conservative management of the condition.

Classification of contour deformities after massive weight loss: the applicability of the Pittsburgh Rating Scale in The Netherlands.

BACKGROUND: The Pittsburgh Rating Scale is the only validated classification system of skin deformities occurring after massive weight loss. The purpose of this study was to replicate the validation of the Pittsburgh Rating Scale classification and to evaluate its usefulness in the treatment of massive weight-loss patients in The Netherlands. METHODS: Thirteen trained observers applied the Pittsburgh Rating Scale to photographs of 25 patients. These photographs showed the 10 regions of the body for which the Pittsburgh Rating Scale is designed. Six of the observers were medical specialists, three were medical interns in plastic surgery and four observers were specialised nurse practitioners. As a measure of inter-rater agreement we calculated the intraclass correlation with a threshold value of 0.6 for good validity. The observers also answered 11 questions about the scale's usefulness in daily practice. RESULTS: In two consecutive tests the photographs of 10 regions were scored, which resulted in a total of 20 observations per patient. Sixty percent of the intraclass correlation values were below the threshold of 0.6 for good validity. The mean intraclass correlation value was 0.577. CONCLUSIONS: The Pittsburgh Rating Scale could not be validated as a reliable classification system for skin deformities after massive weight loss. The scale however seems to be a good first step in a challenging task. There was no doubt among the observers that a good classification system would be beneficial for adequate treatment. A modified Pittsburgh Rating Scale should include, besides anatomical parameters, functional disability and hygienic impairment scores and perioperative risk factors.