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PubMed1989

Effect of a selective V1 vasopressin receptor antagonist on the sequelae of endotoxemia in the conscious rat.

The following studies were designed to evaluate the efficacy of a potent and selective AVP V1 receptor antagonist ([1-beta-mercapto-beta, beta-cyçlopentamethyleneproprionic acid, 2-(O-methyl)tyrosine-8-arginine vasopressin]; AVPRA) in limiting the sequelae of endotoxemia. At 0.5 and 1.0 hr after intravenous injection of 30 mg/kg S. enteritis endotoxin (LPS) to male Sprague-Dawley rats, AVP plasma concentrations were increased to 171 +/- 20 and 100 +/- 24 pg/ml, respectively, and were significantly greater than the vehicle control values of 1 pg/ml. Injection of LPS was accompanied by the following: a decreased survival rate (20%) with a mean survival time of 21.6 +/- 6 hr (n = 10), an increased heart rate (+ 84 +/- 22 bpm), a reduced circulating platelet count (23% of initial), and an acute hemoconcentration that was maximal at 30 min after injection of LPS. In a separate group of conscious rats, it was determined that AVPRA (1-100 mg/kg/hr) produced a dose-dependent, parallel and rightward shift in the AVP vasopressor dose-response curve: the highest dose of AVPRA (i.e., 100 micrograms/kg/hr) produced approximately a 1,000-fold shift in the AVP dose-response curve. Administration of AVPRA (1-100 micrograms/kg/hr) beginning 15 min prior to the injection of LPS and continuing for 6 hr did not significantly limit any of the sequelae produced by endotoxemia. These results suggest that, in this model, acute administration of a potent V1 AVP antagonist (AVPRA) is not sufficient to prevent the cardiovascular sequelae and mortality associated with endotoxemia.

Animals↗
PubMed1989

[Moped accidents. A prospective study on the causes of accidents, injury patterns and sequelae].

In a one year prospective investigation, the circumstances and sequelae of 75 moped accidents were registered. The patients were aged mainly between 14 and 18 years and the accidents happened mainly in the afternoon hours. The majority of the injuries were on the head and the extremities. Twenty-one of the patients were admitted to hospital for median 4.8 days, 50 were treated as outpatients and four were dead on admission. The patients were contacted one year after the accident and one had severe sequelae and five had minor sequelae.

Accidents, Traffic↗
PubMed1989

[Isolated cerebral calcifications after prophylactic treatment of cerebromeningeal involvement of acute lymphoblastic leukemia: relation of psycho-intellectual sequelae].

Intracranial calcifications were demonstrated by CT scan in 5 children after complete remission of acute lymphoblastic leukemia (ALL). Initial treatment included prophylactic irradiation of central nervous system and intrathecal methotrexate. Behavioral abnormalities or learning difficulties were clinically apparent in all children at the time of the radiologic examination. Isolated intracranial calcifications represent one of possible cerebral sequelae that are to be found in 53% of children receiving treatment for ALL. No fine correlation between direct toxic effect of methotrexate or, post-radiation lesion, and neuro-psychological sequelae can be done. In an attempt to avoid some of this sequelae, suppression of cranial irradiation from ALL treatment protocols is now studied.

Brain Diseases↗
PubMed1989

[Evaluation of the sequelae of occupational asthma].

Current knowledge of the evolution of occupational asthma is based on few clinical studies in groups of patients sensitized to red cedar, colophony, crab boiling water and organic isocyanates. Whatever the sensitizing agent, respiratory sequelae appear to be very frequent (50% or more of subjects removed from exposure) and characterized by the persistence of an asthmatic condition with a variable degree of severity. For the greater part of these cases certain features at the time of diagnosis assessment appear to be of prognostic value for evolution: age, duration of occupational exposure, duration of symptomatic exposure, presence of spirometric alterations, degree of bronchial hyperreactivity. In all cases persistence of exposure after diagnosis produced unchanged or worsened symptomatology as a consequence. After removal from exposure the manner of evolution may be classified in three groups (1. recovery, 2. intermittent attacks lasting more than one month after exposure exclusion, 3. persistence of an airflow obstruction); particularities of their distinctive course are to consider when evaluating sequelae: symptomatology, degree of bronchial hyperreactivity, presence of airway obstruction, need for long-term steroid therapy, impossibility to find another employment on account of asthmatic attacks due to effort in coldness or to atmospheric pollutants, finally the course of intermittent attacks which does not allow a full appreciation of the severity of sequelae before six months or even one year of allergen exclusion.

Adult↗
PubMed1987

Surgery in the treatment of sequelae in the soft tissues from radiotherapy.

A series of 151 patients treated surgically for sequelae from radiotherapy of the soft tissues is reported. In 90 cases the resection or destructive surgery was completed by plastic surgery. Satisfactory results were obtained in all 101 cases of somatic sequelae. Clinical cure was obtained after three years in two-thirds of 41 cases in which the somatic sequelae were associated with neoplastic recurrence and in 7 of the 9 cases of radioinduced neoplasms. Postoperative complications were most frequently septic and included fistulas, diastasis, and necrosis of the flap. It is inferred that: 1) to prevent the risk of diastasis, it is advisable to avoid as much as possible tension on the irradiated tissues in the attempt to bring together the margins of the surgical wound; 2) plastic reconstructive surgery allows wide resection in order to reach nondystrophic tissues, to remove latent sepsis and to prevent neoplastic recurrence; 3) an interval, of even more than one month, between the resection and the plastic surgery is often advisable.

Dose-Response Relationship, Radiation↗
PubMed1985

Thrombotic complication of umbilical arterial catheterization and its sequelae.

Umbilical arterial catheterization caused major complications including 5 deaths in 25 of 230 infants who underwent autopsy at the Kandang Kerbau Hospital in a two-and-a-half year period beginning May 1982. Arterial thrombosis developed in 25 of 129 (19.3%) autopsies with a history of umbilical arterial catheterization. Pathological sequelae of thrombosis occurred in 14 cases (peripheral gangrene 1, renal 6, gastrointestinal 3 and both renal and gastro-intestinal 4). The sequelae were clinically unsuspected in the majority. Early deaths were uncommon in the group with thrombosis. Comparison of neonatal factors revealed no significant differences between the group with sequelae and those without. Infants with indwelling umbilical arterial catheter should be actively monitored for complications.

Aorta, Abdominal↗
PubMed1981

Torture sequelae located to the skin.

Torture sequelae and associated diagnostic problems within the field of dermatology are reported. Patient 1 claimed to have been subjected to torture in 1973 in South America and reported that he had a thick rubber-like rope tied around each thigh just above the knees. Six years later a linear zone of alopecia was observed extending circularly around each thigh, probably representing cicatricial alopecia. Patient 2 claimed to have been subjected to torture in November 1978 in Iraq and reported that he was burned on several areas of the skin with a metal rod of the size and shape of a cigarette. One year later, several circular or serpiginous scars with a markedly atrophic centre and a narrow hypertrophic, distinctly demarcated peripheral zone were observed on the skin. They probably represent the sequelae to deep third-degree burns produced by an electrically heated, cylindrical metal rod. Patient 3 claimed to have been subjected to torture in July and August 1974 in India. She reported to have been burned on several areas of the skin with a cigar as well as lifted by her hair. A few days after the torture she developed transient features typical of traction alopecia in the scalp, including the appearance of pimples. The examination 6 years later revealed on the extremities two irregularly shaped and indistinctly demarcated scars, one of them slightly atrophic, which might be sequelae to burns produced by an ember from a cigar.

Adult↗
PubMed1994

[Subtalar arthrodesis for sequelae of calcaneal fractures. Apropos of 57 cases].

PURPOSE OF THE STUDY: 57 subtalar arthrodesis for sequelae of calcaneal fractures were reviewed with a minimum follow up of 6 years 11 months. MATERIAL AND METHODS: Bone resection and interposition of bone grafts, stabilized by screws were used in 36 cases. Iliac crest grafts were used in 20 cases, cryopreserved grafts 15 times and local graft taken on the anterior tibial epiphysis once. No surgery was performed on the mid foot. RESULTS: Results were evaluated using the grading system described by Mestdagh with 33 good global results, 18 fair results and 6 poor results for a total of only 58 per cent of good global results. Of the 57 cases reviewed, 18 remained painful with a limited range of motion for inversion and eversion of the foot. In 18 patients monopodal weight-bearing was unstable. Residual oedema persisted in 5 patients. 16 patients continued to limp and 3 required the use of a crutch. 7 valgus and 3 varus deviations of the hindfoot were noted at follow up with poor tolerance of the varus when compared to exaggerated valgus. Podoscopic examination revealed increase anterior pressure zones responsible for metatarsalgia which was relieved by corrective shoe inserts in 10 patients. Radiographic evidence of fusion could be demonstrated in 55 cases. There was little or no repercussion on the tibio-talar joint. In the Chopart joint we noted 4 cases of osteoarthritis; there were 6 lesions in the talo-navicular joint and no repercussion in Lisfranc's joint. 16 complications of varying severity were noted with 2 nonunions following use of cryopreserved grafts. DISCUSSION: Subtalar arthrodesis for sequelae of traumatic lesion in the hindfoot gives good results in 2 cases out of 3. In our series, 26 per cent of the patients showed degenerative changes in the mid foot unlike the series published by Kempf. As Meary and Mestdagh noted, we found that residual varus or valgus deformity > 10 degrees was poorly tolerated as well as modifications > 20-30 degrees in the vertical ratio between the talus and the calcaneum in the horizontal plane. CONCLUSION: Subtalar arthrodesis is a useful technique giving good results in 2 out of 3 cases of traumatic sequelae in the hindfoot. Triple arthrodesis does not seem indicated when the talus and the calcaneus can be realigned before fusion. Talo-navicular arthrodesis, though more easily realized, requires blocking a normal joint in order to immobilize a painful joint.

Arthrodesis↗
PubMed1994

[The relationship between pulmonary hemodynamics and chest X-ray findings in patients with sequelae of pulmonary tuberculosis].

For better understanding of pathophysiological aspects of tuberculosis sequelae, we investigated the relationship between pulmonary hemodynamics and chest X-ray findings. One hundred and seven patients with sequelae of pulmonary tuberculosis were examined by the right cardiac catheterization, and pulmonary hemodynamic values were measured and calculated. Chest X-ray findings were defined and classified into the following five items. The items were emphysematous change; fibrosis, bronchiectasis and/or cavity (hereafter abbreviated as "fibrosis"); pulmonary resection and/or atelectasis; pleural thickening; and thoracoplasty. The extent of each finding was defined. We tried to describe chest X-ray findings by applying and categorizing these classifications and the extent to each case. First, we tried to estimate the grade of pulmonary hypertension by categorized X-ray findings. Further, we analyzed what kinds of findings were most influential on the increase of pulmonary artery mean pressure (PPA) and pulmonary arteriolar resistance (PAR). Secondly, we investigated whether PPA, cardiac index (CI) and PAR changed before and after oxygen administration. Thirdly, we analyzed what kind of X-ray findings most affected pulmonary hemodynamics under 100% oxygen administration for 10 minutes. The results were as follows: (1) Out of 107 cases, it was possible to predict PPA by categorized chest X-ray findings in 75 cases by Hayashi's first method of quantification, one of multivariative analyses. "Pleural thickening" was the most influential finding on the increase of PPA. "Fibrosis" was the most influential on the increase of PAR. (2) The values of PPA, CI and PAR decreased more after 100% oxygen administration than under room air breathing. Therefore, PAR was used as the index to estimate pulmonary hemodynamics under the condition of oxygen administration. (3) It was possible to measure PAR under oxygen administration (PARO2) in 72 cases. "Emphysematous change" was the most influential X-ray finding on the increase of PARO2. From these results, it was thought that pulmonary circulatory disorder in patients with tuberculosis sequelae was caused by the combination of various chest X-ray findings with the different extent. It was possible to predict pulmonary hypertension to a certain degree from categorized chest X-ray findings. It was suggested that "emphysematous change" less related to hypoxic pulmonary vasoconstriction than "fibrosis" and "pleural thickening" from the results of comparison among the partial correlation coefficients, which were associated with the increase of PAR under room air breathing and oxygen administration.(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗
PubMed1994

[Clinical assessment of diffuse brain injury sequelae: with respect to so-called post-traumatic disorder].

Brain injury sequelae were observed in 24 patients who had sustained diffuse brain injury. According to their ability to lead social life, the severity was classified into 6 levels; vegetative, severe, moderate, mild, fair, and good. The severity levels statistically correlated with the length of the initial unconsciousness (Spearman's correlation coefficient r = 0.929, n = 24, p < 0.01), with posttraumatic amnesia (r = 0.827, n = 8, p < 0.05), with ventricular enlargement (r = 0.808, n = 24, p < 0.01) and with the presence of hemiplegia (r = 0.740, n = 24, p < 0.01). Children and young adults showed a tendency to improve to milder levels. Mild head injury patients who sustained concussion of less than 6 hours in duration also showed minimal sequelae such as mild ventricular dilatation and difficulty in recent memory. This memory impairment had often been ascribed to the so-called postconcussional syndrome. The threshold for occurrence of diffuse brain injury sequelae was estimated as concussion lasting 15-30 minutes or post-traumatic amnesia of a few days in duration in adults and about a week in children. Superficially localized brain contusion was frequently observed and was not correlated with the severity level, hemiplegia or post-concussional syndrome.

Adolescent↗
PubMed1977

Sequelae of abdominal radiation and their medical management.

As various chemotherapeutic agents are added to treatment routines, the possibility of adverse effects is appreciably increased, particularly in those organs for which the agents have specific toxicity. Symptoms most commonly associated with radiation sickness, such as malaise, anorexia, nausea, vomiting, diarrhea, dysphagia, dermatitis, and depleted hemopoietic elements, are usually seen late in the course of radiation therapy or shortly thereafter. Consequently, they are managed by the physician in charge of radiation or the patient's referring physician. The general physician may be concerned with symptoms arising from delayed organ pathology. These symptoms may arise in many tissues that are still considered somewhat radioresistant, but secondary to sequelae arising because of connective tissue changes from obliterative narrowing of the finer vasculature. Radiation may be only one of several possible causes, and the symptoms of sequelae may appear only after a long latent period, so that the previous radiation may not be considered in the differential diagnosis unless a detailed history is taken. The medical management of these sequelae is, in general, similar to that used for the pathology produced in these organs by other agents.

Abdominal Neoplasms↗
PubMed1993

Clinical sequelae of Japanese encephalitis in children.

Over a five and a half year period, virological investigations for Japanese encephalitis (JE) were conducted in children admitted with acute encephalitis like illness to a large city hospital. The diagnosis of Japanese encephalitis was made by viral isolation from cerebrospinal fluid and/or a four-fold or higher rise in haemagglutination inhibiting antibodies in paired sera followed by demonstration of specific IgM antibodies by HI test after treatment with 2-mercapto ethanol. All children surviving the illness were contacted by post and followed up for sequelae. A total of 55 children could be followed up after 12-18 months and 22 of these even after 2 yr. A high rate of major sequelae (45.5%) in the form of frank motor deficits (32.7%), mental retardation (21.8%) and/or convulsions (18.2%) was observed. Neurological deficits were of diverse types and improved even after 2 yr of the illness. Fourteen patients (25.4%) had only minor deficits in the form of scholastic backwardness, behavioural problems and/or subtle neurological signs. Only 16 (29.2%) patients were completely normal on follow up. JE may therefore be an important cause of neurological handicap in this area. Sequelae of the disease were more severe if the initial illness was prolonged (P < 0.001, CI 2.45, 12.64), or associated with focal neurological deficits (P < 0.001, CI 1.97, 7.02).

Child↗
PubMed1996

[An application of semiquantitative analysis of pulmonary scintigram to pulmonary tuberculosis sequelae].

We performed ventilation-perfusion scintigraphy in 13 patients with pulmonary tuberculosis sequelae and 21 with chronic obstructive pulmonary disease. We used 99mTc-MAA for perfusion scintigram and 133Xe gas for ventilation scintigram. We added the radioactivities during the rebreathing phase of the ventilation scintigram to make a computerized image of the lung volume. Regions of interest (ROIs) were derived from radioactivities on each image. ROIs included each whole lung on lung volume (L) image and areas where radioactivity was greater than 70% of the highest radioactivity on perfusion (P70) image. We counted the area of ROIs on L and P70, and used the ratio of perfusion to lung volume (P70/L) as a parameter of pulmonary perfusion. P70/L in patients with pulmonary tuberculosis sequelae was significantly higher than that in those with COPD. This suggested that the area of high pulmonary perfusion is larger in the patients with pulmonary tuberculosis sequelae as compared with those with COPD.

Aged↗
PubMed1996

Skin expansion in burn sequelae: results and complications.

Before Radovan introduced skin expansion, burn sequelae were treated with skin grafts, local or distant flap, with an high morbidity on the donor site. Actually this technique is well known and standardized procedure that allows to obtain local flaps with the same characteristics in colour, texture, hair and sensitivity of the normal skin. The authors analyze their experience in the treatment of burn sequelae from 1985 to 1995. During this period, 157 patients underwent surgery to correct burn scars and contracture, utilizing 262 skin expanders. The implants were positioned on the fascial layer; antibiotic and drainage were routinely used. The inflation of the expander began 2 weeks after surgery, and hyperexpansion was the rule, when possible. Only in 6.4% (10 patients) expansion failed, while in the remaining cases good partial (in patients with too large scars) or total results were achieved. Complication rate in skin expansion is high. In this series complication occurred in 73 of 262 expansion, but 43 were easily solved. So only in 30 expansions the final outcome was influenced by complication, with higher incidence in neck and in lower extremities. Results were generally satisfactory, with an improvement of scars and minimal donor site morbidity. With a careful selection of the patients, skin expansion offers a good solution for burn sequelae, complications can be reduced and successfull results achieved.

Adult↗
PubMed1997

Leg lengthening by the Ilizarov technique for patients with sequelae of poliomyelitis.

Limb length discrepancy is common in patients with sequelae of poliomyelitis. However, treatment of this problem is difficult and complicated. From 1988 to 1993, 71 patients with sequelae of poliomyelitis were treated with leg lengthening by modifications of the Ilizarov technique. Their median age at surgery was 26.4 years (range, 11.6-38.1 yr). Patients were divided into four groups according to the method of treatment, with femoral lengthening in 18 patients, combined femoral and tibial lengthening in 6, tibial lengthening in 35, and tibial lengthening along and intramedullary locking nail in 12. At follow-up of 2 to 6.7 years, the combined femoral/tibial group had the greatest gain in length. Treatment time in the Ilizarov device was shortest in the tibial lengthening with locking nail group. The lengthening index, which was defined as days in the Ilizarov device required for each centimeter of lengthening (days/cm), was lowest in the tibial lengthening with locking nail group, followed by the combined femoral/tibial lengthening group. Complications such as soft tissue contracture, callus fracture and residual deformities were most common in the combined femoral/tibial lengthening group and the femoral lengthening group. Complications were least common in the tibial lengthening with locking nail group. The satisfaction rate was highest in the tibial lengthening with locking nail group. We found that in leg lengthening for patients with sequelae of poliomyelitis, callus maturation was slow, and patients tended to develop contractures despite physiotherapy, bracing or joint fixation. Concomitant and secondary surgery were frequently required to treat associated problems or residual deformities. Lengthening along an intramedullary locking nail can significantly shorten the treatment time with relatively few complications.

Adolescent↗
PubMed1997

[Surgery of thoracic and pulmonary tuberculosis and the sequelae of its treatment in adults].

Surgery for tuberculosis was the starting point for thoracic and cardiovascular surgery in the modern day, but its place was more and more restricted to the treatment of the disease. Excisions (lobectomies, pneumonectomies, segmentestomies) currently represent the majority of operations, after this come operations on the pleura (decortication) and rarely those on the thoracic wall (thoracoplasty, parietectomy). The indications for excision are principally encountered with disease of the parenchyma itself: progressive disease under treatment or with resistant tubercle bacilli, sequelae of parenchymal complications (infections, aspergilloma or haemoptysis) and certain forms of atypical mycobacteria, and also a small but significant group in which excisions are aimed at diagnosis. Sometimes excisions are associated by necessity with decortication for pleural disease which may or may not have originally been intended for the underlying parenchyma or the lesions may be the sequelae of previous complications of treatment such as collapse therapy. Occasionally surgery is indicated in the treatment of lymph node masses in the mediastinum which have not responded to antituberculous therapy and during the treatment bronchial complications have evolved or there have been other sequelae. As for the indications for surgery of the thoracic wall such as thoracoplasty, they appear more than ever obsolete and even if they are still used in certain complications of surgery, they have apart from a few exceptions, lost their original therapeutic role in tuberculosis. However, currently there is a recrudescence of tuberculosis favoured by certain socio-economic situations and strengthened by the appearance of TB cultures which are more and more resistant. The surgery of tuberculosis in its oldest forms (thoracoplasty and removal of cavities) can no longer be said to be the surgery of the past. They proved in the old days that they could cure. Surgery has once more its place in the therapeutic arsenal of new forms of the disease and indirectly in limiting the risk of spread it has a role to play in prevention.

Adult↗
PubMed1996

[Skin flaps and expanded full-thickness skin grafts. Indications in the repair of burn sequelae].

The great majority of sequelae of deep burns concern the skin. Their correction essentially raises problems of replacement of scarred skin by good quality skin. Sequelae of burns logically constitute one of the best indications for progressive mechanical skin expansion by prosthesis, which allows for considerable improvement of the aesthetic results. This improvement is related to the use of skin replacement tissues with the same quality as the original tissue. Local expanded flaps and expanded full-thickness skin grafts are the two essential techniques used. The authors review the general rules concerning the use of expansion prostheses, then describe the various indications for expanded flaps and expanded full-thickness skin grafts in the sequelae of burns of the face, neck, thorax and limbs. The main indications are illustrated by clinical cases.

Burns↗
PubMed1998

Ocular sequelae of BB injuries to the eye and surrounding adnexa.

BACKGROUND: BB injuries continue to be one of the most common causes of severe ocular injury among adolescent males. Extraocular and nonperforating anterior globe injuries most commonly result in favorable visual outcomes. The appropriate medical management of both perforating and nonperforating anterior globe injuries resulting from BB trauma and their potential ocular sequelae are reviewed. CASE REPORTS: Three cases illustrating typical as well as atypical anterior globe injuries caused by BBs are presented. Two cases involve nonperforating anterior globe injuries--one with intracranial and one with intraorbital involvement. The third involves a retained intraocular foreign body. The biomicroscopic and ophthalmoscopic features of these injuries are discussed, as are potential complications and management strategies associated with these types of trauma. CONCLUSIONS: Injuries associated with intraocular BBs often result in enucleation if functional vision is not salvageable. Sequelae to such injuries include endophthalmitis, traumatic hyphema, ocular siderosis, and sympathetic ophthalmia. Plain-film radiography and axial computed tomography are critical first steps in determination of the position of any intracranial or intraorbital metallic foreign body. Routine observation for the development of ocular sequelae resulting from retained intraocular, intracranial, and intraorbital BB injuries is recommended.

Adolescent↗