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PubMed1988

Chronic otitis media and sequelae in the population of Greenland.

It is generally recognized that chronic otitis media and sequelae of this disease are frequently encountered among the native population of Greenland, but the prevalence of chronic otitis in Greenland has not previously been systematically traced. Treatment for this disease has improved and we expect an increased demand for treatment of this disease among Greenland natives. To evaluate the need of treatment the prevalence of chronic otitis media in two large Greenland towns was assessed. The study population included 303 persons aged 11-20 years and 305 aged 41-50 years. Medical histories were recorded and objective examinations were performed using e.g. oto-microscopy. Among the young participants, 8% had chronic suppurative otitis and 14% sequelae of chronic otitis media. Among the older participants, 2% had suppurative otitis and 13% sequelae of chronic otitis. It is estimated, using Scandinavian criteria, that 8.6% of the participants would have benefitted from an ear operation either to stop otorrhea and/or to improve the hearing. The launching of an oto-surgical effort in Greenland is considered justifiable on the grounds of the importance of hearing to communication and the isolation in point of the native Greenland population.

Adolescent↗
PubMed1994

Propofol for ambulatory gynecologic laparoscopy: does omission of nitrous oxide alter postoperative emetic sequelae and recovery?

The role of nitrous oxide in postoperative emesis is controversial. This prospective randomized study was performed to compare the emetic sequelae and quality of recovery between a group of patients anesthetized with propofol alone and a group anesthetized with propofol plus nitrous oxide. Seventy patients, ASA grade I or II, scheduled for ambulatory gynecologic laparoscopy under general anesthesia were included. Most factors which could influence the incidence of postoperative emesis were controlled. The overall incidence of emetic sequelae during the first 24 h postoperatively was 25% in the group anesthetized with propofol alone versus 29% for the group anesthetized with propofol and nitrous oxide. The incidence of emetic sequelae requiring therapeutic intervention was 13% and 6%, respectively. This difference was not statistically significant. The group of patients who received propofol alone required an average propofol dose of 221.5 +/- 71.9 micrograms.kg-1.min-1 to maintain anesthesia compared with 162.5 +/- 43.9 micrograms.kg-1.min-1 for the group receiving propofol plus nitrous oxide (P < 0.001). The time from discontinuation of propofol to eye-opening and orientation was significantly longer in patients anesthetized with propofol alone. Otherwise, the recovery variables were comparable between the two groups. We conclude that supplementing propofol with nitrous oxide in patients undergoing ambulatory laparoscopy reduces the requirements of propofol, expedites immediate recovery (emergence), and does not increase the incidence of postoperative emesis. This tends to confirm that there is no clinical advantage to omitting nitrous oxide.

Adult↗
PubMed1991

Otologic sequelae after pneumococcal meningitis: a survey of 164 consecutive cases with a follow-up of 94 survivors.

As part of a comprehensive study on sequelae after pneumococcal meningitis, 94 of 111 consecutive survivors were re-examined 4 to 16 years after discharge. Twenty-three patients had otological sequelae after pneumococcal meningitis. In these patients, 17 had hearing losses, 7 had tinnitus, 9 had vertigo, 13 had vestibular areflexia, 4 had loss of smell, and 3 had loss of taste. Among the patients with hearing loss, 4 were bilaterally deaf, 6 were unilaterally deaf, and 2 had mild and 5 had slight hearing losses. From correlations with extensive data from the medical records, preadmission antibiotic treatment appeared to protect from acousticovestibular damage. Purulent otitis media and otosurgical intervention did not correlate to the fatality rate or the development of sequelae. Acute purulent otitis media appeared as a concomitant manifestation, rather than the focus of pneumococcal meningitis.

Adolescent↗
PubMed2003

Functional sequelae of tuberculous pleurisy in patients correctly treated.

STUDY OBJECTIVES: To assess the functional sequelae (FS) of patients with tuberculous pleurisy (TP), to analyze the influence of different factors in the occurrence of these FS, and, finally, to evaluate the relationship between the FS and roentgenographic sequelae. DESIGN: An observational, retrospective study. SETTING: A community teaching hospital in Alicante, Spain. PATIENTS AND METHODS: From April 1986 to July 2000, all patients with a firmly established diagnosis of TP, who had been functionally studied at the end of follow-up, were included in the study. A diagnosis of TP was considered to be definitive when the presence of granuloma on a pleural biopsy specimen was demonstrated or when a culture was positive for Mycobacterium tuberculosis in pleural fluid (PF) or tissue. The general characteristics of the study population and PF were compared in patients with or without restrictive FS (ie, FVC or TLC < 80%), looking for risk factors for developing this complication. RESULTS: Eighty-one of 150 patients who had been treated for TP were eligible for the study. At the end of follow-up, eight patients (10%) had a restrictive FS. These patients had a lower PF lactate dehydrogenase concentration (p < 0.001), a higher PF concentration of cholesterol (p < 0.03) and triglycerides (p < 0.03), and a higher percentage of lymphocytes (p < 0.04). A weak correlation was found between the FVC and the intensity of radiographic pleural thickening (r = - 0.298; p < 0.01). CONCLUSIONS: The FS in patients with TP is restrictive in type, infrequent, and usually mild. A higher PF lipid content or a more chronic inflammatory pleural reaction at diagnosis appear to be risk factors for developing a FS. The correlation between FS and roentgenographic sequelae is poor.

Adolescent↗
PubMed1982

Incidence and extent of venous sequelae with intravenous diazepam utilizing a standardized conscious sedation technique.

Twenty-four periodontal patients volunteered for a study designed to investigate the incidence of venous sequelae with Injectable Valium administered by a standardized conscious sedation technique. Sedative doses were injected into veins on the dorsum of the hand utilizing a continuous infusion drip of 5% dextrose in water. Postoperative evaluation extended over 12 weeks. Ultrasonic tests for thrombosis were performed with a Doppler Flowmeter. Independent variables considered included age, vein size, volume of drug, volume of intravenous solution, pain upon injection and initial venous flow velocity. Sixteen subjects (66.67%) experienced some form of venous sequelae. Thirteen sequelae advanced to thrombophlebitis. Those subjects who demonstrated no complications had significantly higher initial venous flow than those with complications. Those subjects with resolution of complications demonstrated a significantly greater initial venous flow than those without resolution of complications. Clinical variables of pain on injection, vein diameter, dose of diazepam and volume of infusion solution did not significantly differ across groups. However, those subjects with no complications were significantly older than those with complications. It is recommended that the larger veins of the forearm and antecubital fossa, with greater mean velocities of venous flow, be preferred for intravenous diazepam administration to attempt to decrease the nature and incidence of thrombophlebitis.

Adult↗
PubMed1983

Incidence and extent of venous sequelae with intravenous diazepam utilizing a standardized conscious sedation technique. Part II: Effects of injection site.

The effects of site of venipuncture on the incidence of venous sequelae, utilizing a standard protocol, were assessed on 48 human subjects. Data were also recorded based on various demographic and clinical variables, including age, sex, race, vein diameter, dose, procedure time, IV fluid volume, injection pain and initial blood flow velocity. When the site of venipuncture was the antecubital fossa there was a significantly lower incidence of venous sequelae than when the venipuncture site was the dorsum of the hand, with the significant variables being venous diameter and procedure time. These findings further support the antecubital fossa as a preferred venipuncture site to the dorsum of the hand; however, there was a sufficient incidence of venous complications (37%) when the antecubital fossa was used to warrant consideration of contributory factors other than site. It appears that time of continuous infusion is a critical element and should be kept at a minimum. Also, subjects in whom Valium was injected demonstrated significantly more venous sequelae than those in whom 5% dextrose in water was injected, confirming previous reports that diazepam is irritating to the endothelial lining and thus is thrombogenic.

Anesthesia, Dental↗
PubMed1992

MR imaging and HMPAO scintigraphy in conjunction with balloon test occlusion: value in predicting sequelae after permanent carotid occlusion.

OBJECTIVE: Permanent occlusion of the internal carotid artery may be required for en bloc resection of a neck tumor or to treat certain aneurysms. The risk of ischemic infarct is usually assessed with carotid balloon test occlusion and concurrent distal arterial pressure measurement. However, up to 20% of patients who tolerate the test occlusion have delayed neurologic sequelae. We propose enhanced MR imaging and hexamethylpropyleneamine oxime (HMPAO) scintigraphy to detect subclinical signs of ischemia and hypoperfusion as adjuncts to the balloon test occlusion to identify patients at risk for delayed sequelae. SUBJECTS AND METHODS: We prospectively examined 12 patients referred for balloon test occlusion of the carotid artery. Serial measurements of distal occluded internal carotid pressure were recorded. 99mTc-HMPAO was injected IV after 2 min of asymptomatic test occlusion, and single-photon emission computed tomographic (SPECT) data acquisition was done 1-6 hr later. Contrast-enhanced MR imaging was performed 1-8 hr after completion of the 30-min test occlusion. Signs of decreased perfusion or ischemia on these tests were compared with the mean distal arterial pressure and neurologic status of the patient during test occlusion. RESULTS: Seven (58%) of 12 patients had abnormal findings on HMPAO scintigraphy or contrast-enhanced MR imaging. Only one patient had neurologic deficits that corresponded to abnormal MR enhancement. The other 11 patients (92%) remained asymptomatic during the 30-min test occlusion. Of these 11 asymptomatic patients, five (45%) had areas of decreased perfusion on scintigraphy and three (27%) had abnormal MR contrast enhancement suggesting residual focal ischemia as a result of the test occlusion. Mean arterial pressures in the distal occluded artery did not correlate well with the imaging results. CONCLUSION: HMPAO scintigraphy can show clinically silent areas of decreased perfusion, while enhanced MR shows signs of acute ischemia (i.e., significant hypoperfusion) associated with asymptomatic balloon test occlusion. Theoretically, such patients would be at increased risk for permanent sequelae after permanent carotid occlusion.

Adult↗
PubMed1994

Bronchopulmonary dysplasia: value of CT in identifying pulmonary sequelae.

OBJECTIVE: Pulmonary dysfunction is common in children who survive bronchopulmonary dysplasia. Chest radiographs are not satisfactory for the identification of the sequelae of bronchopulmonary dysplasia because, although they often show abnormalities, the abnormalities are usually minor and sometimes absent. We therefore assessed the value of CT for identifying the sequelae of bronchopulmonary dysplasia. MATERIALS AND METHODS: Twenty-three children (mean age, 4 years) who had survived neonatal bronchopulmonary dysplasia and had signs of chronic pulmonary dysfunction (recurrent episodes of coughing, wheezing, dyspnea, pneumonia, respiratory insufficiency) were examined with chest radiographs and high-resolution CT scans of the chest. Two reviewers qualitatively analyzed the chest radiographic and CT findings by describing the most consistently found lesions and their frequencies. RESULTS: The chest radiographs showed hyperexpansion in 17, hyperlucent areas in 11, and linear opacities in 10 of the 23 children. Pleural thickening was not observed, and four children had normal findings on chest radiographs. All 23 CT scans showed abnormalities, including multifocal areas of hyperaeration, well-defined linear opacities, and triangular subpleural opacities with an external base and an internal apex. In 20 of 23 children, all three abnormalities were present. For the three other children, two of these three abnormalities were found. No bronchiectasis was observed in any of the cases. CONCLUSION: Lesions in survivors of bronchopulmonary dysplasia with chronic pulmonary dysfunction are visualized better on CT scans than on chest radiographs. Importantly, CT findings of multifocal areas of hyperaeration, numerous linear opacities facing triangular subpleural opacities visible on several consecutive sections, and no bronchiectasis should suggest the presence of sequelae of bronchopulmonary dysplasia.

Bronchopulmonary Dysplasia↗
PubMed1996

The psychological sequelae of miscarriage: a critical review of the literature.

Miscarriage, although a common event in pregnancy, has been frequently overlooked in psychological research. This paper reviews the literature on the psychological sequelae of miscarriage, including the shortcomings of that literature. Best understood against the background of psychological changes in early pregnancy, the literature reveals aspects of grief specific to miscarriage. Important components of this grief comprise high levels of guilt, the loss of part of the self and a large impact upon personal identity. The psychological sequelae impact upon other family members, including partners and surviving children. Psychiatric consequences include depression, anxiety and posttraumatic stress disorder. Given the potentially serious nature of these sequelae, it behooves the psychiatrist to inquire routinely about pregnancy loss in all female patients.

Abortion, Spontaneous↗
PubMed1992

Technetium-99m HM-PAO SPECT in patients with delayed neurologic sequelae after carbon monoxide poisoning.

We used single photon emission computed tomography (SPECT) with technetium-99m hexamethylpropylene amine oxime (99mTc-HM-PAO) in 14 studies on 6 patients with delayed neurologic sequelae from carbon monoxide (CO) poisoning to determine whether any changes in cerebral blood flow could be correlated with clinical or computed tomographic evidence of delayed deficits. Among the six initial CT brain scans, two showed low density of both basal ganglia and two showed decreased density of the cerebral white matter. There was no correlation between the clinical outcome and the findings of the follow-up CT brain scans. Of the two SPECTS with 99mTc-HM-PAO performed during acute anoxic insult, one showed focal hypoperfusion which appeared 20 days prior to the onset of delayed neurologic sequelae after CO poisoning. Seven SPECTs in the six patients performing the delayed phase showed diffuse patched patterns of hypoperfusion which improved on follow-up images. There was good correlation between the clinical outcome and the findings of the 99mTc-HM-PAO SPECT. In preliminary conclusion, 9Tc-HM-PAO brain SPECT can be used for predicting or evaluating the outcome of delayed neurologic sequelae after CO poisoning. Cerebral vascular changes may be the possible cause of hypoperfusion in patients with CO poisoning.

Adult↗
PubMed1985

Post-polio sequelae--differential diagnosis and management.

Forty-two patients with a past history of poliomyelitis were evaluated at a post-polio clinic for new problems or impairments. Evaluation included a complete history, neurological and biomechanical examination and electrodiagnostic studies. Based on this evaluation patients were placed into three groups: 23 patients were considered to have or likely to have Progressive Post-Polio Muscular Atrophy (PPPMA); 17 patients were considered to have other post-polio sequelae; and two patients had problems unrelated to a past history of polio but mistaken for post-polio sequelae. Musculoskeletal pain was a common complaint among all groups of patients. Twenty-two of the 40 patients with post-polio sequelae were advised to alter their method of ambulation and/or decrease their activity pattern in order to decrease strain and/or excessive exertion of involved muscles. The role of chronic overuse and exercise in producing PPPMA or musculoskeletal pain problems is discussed. Characteristic clinical problems and useful management plans are described.

Adult↗
PubMed1989

[Prognostication of sequelae in Bell's palsy].

Four symptoms of sequelae (abnormal synkinesis, facial spasm, contracture, and crocodile's tear) which persisted or appeared after 6 months from onset were examined with 351 patients with Bell's palsy. The incidence of sequelae were 2% in the group having score (May-Hosomi's modified method, 90 points method) over 40 points within 1 months after onset. Other hand, the incidence of sequelae were 15% in the group having score under 40 points at 1 weeks from onset, 30% in the group having score under 40 points at 2 weeks, 57% in the group having score under 40 points at 3 weeks, and 76% in the group having score under 40 points at 1 month. From these findings, it was seen that the prognostication with a high accuracy was possible by the score.

Adolescent↗
PubMed1993

Mortality and sequelae due to cerebral malaria in African children in Brazzaville, Congo.

This study was carried out on 170 children admitted to the University Hospital of Brazzaville (Congo) for cerebral malaria between January 1, 1988 and June 30, 1989. The selection criteria were 1) unarousable coma, cerebrospinal fluid without microorganisms or a marked cellular reaction, and the absence of other causes, and 2) that the children lived in Brazzaville. The case fatality rate was 15%. In 75% of the cases, death occurred within the first 48 hr. The prognosis worsened with the stage of the coma and a younger age. At discharge from the hospital, 9% of the cases presented with sequelae. The postcerebral malaria mortality was high; indeed, death occurred in six (7%) of 90 children discharged from the hospital whose parents were contacted between nine and 27 months later. Two deaths were directly related to neurologic sequelae. Among the 58 children examined under satisfactory conditions between nine and 27 months (mean 16.9 months) after discharge, 50% (3 of 6) still presented with attenuated forms of the sequelae observed immediately after the episode of cerebral malaria (cortical blindness had regressed completely, unlike ataxia and loss of balance). Disorders that may have been related to the episode of cerebral malaria were observed in 31% of these 58 cases.

Adolescent↗
PubMed2000

Acute onset hemoglobinemia and/or hemoglobinuria and sequelae following Rh(o)(D) immune globulin intravenous administration in immune thrombocytopenic purpura patients.

Rh(o)(D) immune globulin intravenous (anti-D IGIV) was licensed by the United States Food and Drug Administration (FDA) in March 1995 to treat patients with immune thrombocytopenic purpura (ITP). Anti-D IGIV induces extravascular hemolysis, an expected adverse reaction that is consistent with the presumed mechanism of action. Between licensure and April 1999, the FDA received 15 reports of hemoglobinemia and/or hemoglobinuria following anti-D IGIV administration that met the case definition for this review. The mechanism responsible for hemoglobinemia and/or hemoglobinuria is unexplained. Review of these reports was prompted by the seriousness and the unexpectedness of treatment-associated sequelae experienced by 11 patients. Of these patients, 7 developed sufficient onset or exacerbation of anemia that orders were written for packed red blood cell transfusions, although only 6 patients were transfused. Eight patients experienced the onset or exacerbation of renal insufficiency, and 2 patients underwent dialysis. One patient died due to complications of exacerbated anemia. Six patients experienced 2 to 3 sequelae. Absent validated incidence data, a 1.5% estimated incidence rate from published clinical trial data and a 0.1% estimated reporting rate from FDA and drug utilization data were calculated for reported cases of hemoglobinemia and/or hemoglobinuria. This review presents the first case series of anti-D-IGIV-associated hemoglobinemia and/or hemoglobinuria and provides pretreatment and posttreatment clinical and laboratory findings of the case series patients. The primary purpose of this review is to increase awareness of this potentially serious occurrence among physicians and health care professionals who manage ITP patients treated with anti-D IGIV, thereby enabling prompt recognition and treatment of sequelae. (Blood. 2000;95:2523-2529)

Adolescent↗
PubMed2000

Recognized globe perforation during strabismus surgery: incidence, risk factors, and sequelae.

BACKGROUND: Inadvertent perforation of the globe is a well-recognized complication of extraocular muscle surgery. We evaluated the incidence, risk factors, and sequelae of this complication at our institution. METHODS: Medical records of patients who underwent extraocular muscle surgery at King Khaled Eye Specialist Hospital, Saudi Arabia, between September 1983 and April 1997, were reviewed for the occurrence of globe perforation. We documented preoperative visual acuity and refraction, surgical procedure, how the perforation occurred, and immediate management, as well as the sequelae of the perforation, its management, and final outcome. RESULTS: Recognized perforations occurred in 15 of 4886 procedures, for an overall incidence rate of 3/1000. Perforations were 3 times more common in myopic eyes (>-6.00 D, P =.05) and 2 times more common in eyes with previous extraocular muscle surgery. Perforations occurred during muscle reattachment (5 cases), placement of traction sutures at the limbus (4 cases with transient hyphema), muscle disinsertion (3 cases), and placement of sutures at the muscle insertion before disinsertion (3 cases). One patient had a large scleral laceration with uveal prolapse, necessitating scleral patch graft at the time of surgery, and later had retinal detachment surgery with loss of 2 lines of visual acuity. Endophthalmitis, cataract, glaucoma, and phthisis bulbi were not encountered in our review. CONCLUSION: The current incidence of globe perforation is low and only rarely associated with serious sequelae.

Adolescent↗
PubMed2002

Reactive arthritis and other sequelae following sporadic Salmonella typhimurium infection in British Columbia, Canada: a case control study.

OBJECTIVE: To describe sequelae occurring in the 3 months after sporadic Salmonella typhimurium (ST) infection in British Columbia (BC), Canada. METHODS: We compared the incidence of sequelae to similar symptoms in controls; identified risk factors for developing sequelae; identified the incidence of reactive arthritis (ReA) as diagnosed by a rheumatologist, and assessed primary care physician diagnosis of ReA. A questionnaire was administered by telephone to cases of ST occurring in BC between December 1, 1999, and November 30, 2000; and to controls obtained from the BC provincial client registry. Cases reporting symptoms were followed up by a rheumatologist. RESULTS: Thirty-five of 66 (53%) cases reported any symptom, 17 (26%) reported joint symptoms. The Mantel-Haenszel odds ratio (weighted by sex and pediatric/adult) of a salmonella case reporting "any symptom" compared to controls was 5.42; 95% confidence interval (CI) 2.18-16.27; and reporting joint symptoms was 4.40; 95% CI: 1.25-19.53. The sex distribution of cases reporting joint symptoms was not significantly different. No medication taken during the salmonella infection was significantly different between the cases who had joint symptoms and those who did not. Four cases (2 adults, 2 children) were considered by the rheumatologist to have symptoms consistent with ReA, 2 of these had been told by a physician that their symptoms were related to their ST infection. CONCLUSION: Cases were more than 4 times more likely to report joint symptoms than controls; and despite the loss of many cases to followup, 6% of all cases were considered to have ReA.

Adolescent↗
PubMedDate not supplied

Laryngeal sequelae of endotracheal anesthesia.

The endotracheal administration of anesthesia has been improved considerably in the past decade. By reducing mortality and morbidity, this modality has made possible many advances in all forms of surgery, especially of the chest, head, and neck. There are, however, some disadvantages: 1. The endotracheal tube is a foreign body and thus can cause irritation. 2. Lubricants and solutions used for cleansing and sterilizing the tube may be irritating and can produce a membrane which obstructs the airway. 3. The lumen of the airway is reduced, an especially hazardous problem in children. 4. The patient must be under deeper anesthesia for intubation than is sometimes necessary for the surgical procedure. 5. There may be trauma to teeth, pharynx, nose, or trachea during intubation. 6. Coughing or straining may cause increased venous pressure, with undesired effects. 7. Bacteria from the nose may be carried to the lower respiratory tract. 8. Pulmonary sequelae may occur. 9. Laryngeal sequelae may occur. It is with laryngeal sequelae that we are concerned in this (1951) presentation, which includes the reports of 8 cases of laryngeal obstruction, with 2 deaths, and 7 cases of laryngeal granulomas.

Anesthesia, Endotracheal↗
PubMed2003

Managing the oral sequelae of cancer therapy.

Patients undergoing systemic chemotherapy and/or head and neck radiotherapy frequently experience treatment side effects. Oral complications are among the most common problems associated with these therapies. These sequelae include mucositis, oral hemorrhage, infection, and xerostomia (dry mouth). Occasionally, oral complications are so severe that the cancer treatment must be reduced or even terminated. By providing comprehensive care, nurses work to help prevent, identify, and manage these oral sequelae, and thus maximize quality of life. Limiting the effects of oral sequelae increases patient adherence to treatment protocols, improves the quality of life, and increases the odds of long-term survival.

Antineoplastic Agents↗