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PubMed1993

Long-term mental sequelae of political imprisonment in East Germany.

This paper presents an assessment of the long-term mental sequelae of prolonged stress due to political persecution and imprisonment in the German Democratic Republic. Fifty-five former political prisoners with enduring psychiatric disorders were examined retrospectively in an exploratory study. The patients' experiences before, during, and after imprisonment were investigated using a semistructured interview. Psychopathological symptoms were assessed on clinical and self-rating scales; diagnostic classification was conducted according to DSM-III-R. The patients had experienced serious trauma, including psychological torture, long-term imprisonment, and solitary confinement. We diagnosed a characteristic syndrome involving symptoms of depression and anxiety with vegetative complaints and increased arousal. In 35 (64%) patients, the symptoms persisted over an extended period without improvement. This syndrome resembles psychiatric disorders found after other forms of political persecution. It may be concluded that prolonged individually experienced political stress situations, even if they are not life-threatening, may have long-term mental sequelae.

Adult↗
PubMed1997

Long-term mental sequelae of torture in Iran--who seeks treatment?

In this study, we investigated long-term mental sequelae of torture in Iran and explored differences between treatment seekers and nontreatment seekers. Thirty-four torture victims suffering from enduring mental sequelae and now living in Germany were examined. According to DSM-III-R, depressive, anxiety, and somatoform disorders were diagnosed with a high degree of comorbidity and with posttraumatic stress disorder (PTSD) being the most frequent diagnosis. Treatment seekers had a higher level of psychopathology, particularly the PTSD symptoms of intrusion and increased arousal, and a poorer knowledge of German. They reported different ways of coping. The differences found between the two groups may reflect more or less successful adaptation to conditions in the host country and contribute to the motivation to seek treatment.

Acculturation↗
PubMed2000

The Sierra Leonean refugee experience: traumatic events and psychiatric sequelae.

Although a number of studies address the mental health status of refugees from a variety of regions in the world, there are no studies of the mental health status of West African refugees. It was the purpose of this study to determine the prevalence of various traumatic events to which a sample of Sierra Leonean refugees have been exposed as well as psychiatric sequelae associated with such exposure. A procedure of probability sampling was used to identify and assess a sample of 55 Sierra Leonean refugees residing in a UNHCR-sponsored camp in The Gambia, West Africa. The Harvard Trauma Questionnaire and the Hopkins Symptom Checklist-25 served as survey instruments. The findings clearly indicate the presence of disturbingly high prevalence rates for various traumatic experiences and psychiatric sequelae. It appears that a significant mental health problem exists that begs to be addressed.

Adult↗
PubMed1983

Characteristics and sequelae of peritonitis in diabetics and nondiabetics receiving chronic intermittent peritoneal dialysis.

To evaluate the effect of diabetic status upon peritoneal dialysis-associated peritonitis, the characteristics and sequelae of 159 episodes of peritonitis were reviewed in 26 diabetic and 59 nondiabetic peritoneal dialysis patients. There was no difference between the two patient groups in peritonitis occurrence rates or in individual patient attack rate. The spectra of etiologic florae were comparable, although the nondiabetic group had a greater incidence of Staphylcoccus aureus and fungal peritonitis. Presenting symptomatology, ascitic fluid characteristics, duration of illness, and sequelae of peritonitis, including catheter loss and death, were similar in diabetics and nondiabetics. Dialysis peritonitis is manifested by a spectrum of illness ranging from brief asymptomatic infection to painful prolonged disease; however, the latter course is not more common in diabetics. Further, in diabetics, peritonitis is neither a more frequent event, nor inherently a greater risk, than in nondiabetics.

Diabetes Complications↗
PubMed2000

Posttreatment sequelae of palliatively treated cerebral arteriovenous malformations.

OBJECTIVE: Posttreatment sequelae of palliatively treated cerebral arteriovenous malformations (AVMs) were studied to evaluate the significance of these nonradical treatments. METHODS: Between 1987 and 1997, 46 patients with cerebral AVMs were managed with treatments such as partial embolization, radiosurgery, subtotal resection, or feeder ligation alone. Their AVMs were not radically resected because of difficulties in radical treatment, hesitance to treat eloquent area lesions, or residual nidi after subtotal obliteration. The patients' posttreatment sequelae were evaluated. The duration of follow-up ranged from 0.5 to 169 months (mean, 49.4+/-39.8 mo). RESULTS: Twenty-six bleeding episodes from AVMs were documented in 18 patients. The annual risk of bleeding in this palliatively treated group was 14.6%. Persistent progressive neurological deficit was observed in one patient. Major neurological deficits occurred in 10 patients (23.3%), and the mortality rate was 9.3%. CONCLUSION: Palliative treatments cannot prevent bleeding and may even worsen the posttreatment course compared with the natural history of cerebral AVMs. A more conservative indication is required in recommending palliative treatment alone.

Carotid Arteries↗
PubMed1996

The sequelae of childhood sexual abuse: a primary care focus for adult female survivors.

Researchers have increasingly demonstrated that 15% to 30% of all women have been sexually abused as children. Information on the emotional, behavioral, and cognitive sequelae of this abuse has been available. Most recently, a literature on the somatic and medical sequelae has developed. This article reviews this literature and discusses its implications for primary care providers. Survivors are likely to suffer from insomnia, gastrointestinal problems, obesity, chronic pain, headache, and somatization, and they are frequent utilizers of primary care services. Specific suggestions about history taking, physical examination, and referrals are given to ensure that survivors receive care that is sensitive, supportive, and competent. The article also discusses the dynamics of abuse and how they relate to the ongoing relationship between the primary care provider and the survivor of sexual abuse.

Adult↗
PubMed2000

Severe La Crosse encephalitis with significant neurologic sequelae.

La Crosse encephalitis, a member of the California arbovirus group, is the most common cause of reported mosquito-borne illness in the United States. Approximately 70 cases of La Crosse encephalitis are reported each year. The principal vector is the mosquito Aedes triseriatus. During the summer the virus is amplified horizontally in a cycle among small mammals such as chipmunks and squirrels. Infected female A. triseriatus deposit eggs in the basal holes of hardwood trees, although man-made containers and old tires containing water also supply a suitable breeding site. Some of these eggs infected with La Crosse virus hatch the next spring and give rise to infected adult A. triseriatus, and the host-vector cycle is renewed. Only a minority of children infected with the virus become ill. Clinical disease caused by La Crosse is usually mild, and neurologic sequelae are relatively uncommon. In this report we describe six patients with severe La Crosse meningoencephalitis diagnosed within a 4-week period. All patients required intensive care management, and there was a high rate of neurologic sequelae, suggesting that La Crosse is not necessarily a benign meningoencephalitis.

Adolescent↗
PubMed1997

Abdominal sequelae after pedicled TRAM flap breast reconstruction.

A considerable interest in autologous tissue breast reconstructions has developed recently, especially since Food and Drug Administration (FDA) experts have raised the polemic on silicone implants. Although such enthusiasm for the transverse rectus abdominis musculocutaneous (TRAM) flap is justified in what concerns the final cosmetic result of the reconstructed breast, the risk of abdominal sequelae should be explained to the patient. Abdominal scarring, parietal weakness, strength loss, and back pain have been recorded in a series of pedicled TRAM flap reconstructions performed at the Institut Gustave-Roussy before 1991. Cosmetic results of the abdomen were tested by three independent judges on the photographs taken of 132 patients. The global appearance of the abdomen was rated as "natural" in 70 percent of the patients. The umbilical scar was unacceptable in 25 percent and very good or not visible in 21 percent. The lower abdominal scar was rated as "not acceptable" in 35 percent. Abdominal strength was tested among the 38 patients who underwent both preoperative and postoperative muscular testing, of whom 18 had single-pedicled and 20 had bipedicled TRAM flap reconstructions. In the first group, the physiotherapist observed an impairment of function of the upper portion of the rectus abdominis and of the oblique muscle in almost 50 percent. In the second group, the same muscles were more severely impaired (in 60 percent), as well as the function of the lower portion of the rectus (in 15 percent). The percentage of patients complaining of "light back pain" in the 6-month postoperative period was 55 percent in the single-pedicle group and 30 percent in the double-pedicle group. However, 20 percent of the bipedicled patients complained of "severe" back pain, while there was none in the single-pedicled group. In conclusion, abdominal sequelae after TRAM flap breast reconstruction should not be underestimated and constitute one of the drawbacks of the technique when it is compared with reconstruction with a prosthesis.

Abdominal Muscles↗
PubMed1998

Juvenile dermatomyositis and polymyositis: a follow-up study of long-term sequelae.

BACKGROUND: Juvenile dermatomyositis/polymyositis (DMS/PM) are childhood inflammatory myopathies that normally affect children between 2 and 15 years of age. The disease is manifested as severe proximal muscle weakness and, in JDMS, as a characteristic cutaneous eruption. It is difficult to predict the course of the disease. This study is aimed at objectively assessing the long-term morbidity of dermatomyositis/polymyositis in children. METHODS: Twelve cases of JDMS/PM identified through chart review were evaluated by physical and dermatologic examination, muscle testing, ultrasonography, and magnetic resonance imaging (MRI). RESULTS: The patient population included 6 male and 6 female patients with a mean age of 18.8 years (standard deviation 12.4). The mean age at onset of JDMS/PM was 5.8 years (SD 2.8), and the mean time from onset of symptoms to beginning of the study was 10.1 years (SD 9.3). The mean duration of corticosteroid therapy was 53.1 months (SD 40.5), with patients reporting an average of 1.7 relapses (SD 1.5). Patients compared their own activity level with that of healthy control subjects, and on a scale of 1 to 5 with 5 being normal, their mean score was 3.9 (SD 0.9). Fifty-eight percent of the patients had at least one residual finding on physical examination, and 78% of those with JDMS had residual dermatologic sequelae. Despite these findings, the mean grade for the group was 4.6 (SD 0.6) for muscle strength, using a scale of 0 to 5 with 0 being no muscle resistance and 5 being normal. In 60% of patients examined by ultrasonography, increased echogenicity indicated possible residual fibrotic change in at least one muscle group. Although MRI showed no active disease process in four patients, scattered intramuscular calcification was found in one patient. CONCLUSIONS: Multiple physical and dermatologic sequelae are commonly present in patients with JDMS/PM on long-term follow-up, but these do not preclude a productive life. Ultrasonography and MRI provide additional noninvasive means of analysis, but because of the current high cost, MRI is not routinely recommended.

Adolescent↗
PubMed2004

Long-term results on abduction and external rotation of the shoulder after latissimus dorsi transfer for sequelae of obstetric palsy.

Transfer of the latissimus dorsi to the rotator cuff is widely used for restoring shoulder abduction and external rotation in sequelae of brachial plexus palsy; however, its long-term results are not well known. Because persistence of clinical benefits is crucial for children with brachial plexus palsy, the aim of our study was to evaluate retrospectively the long-term results of this transfer in 203 children. Patients were classified according to type of paralysis (C5-C6, C5-C6-C7, and complete), degree of preoperative shoulder function according to Gilbert, and age at surgery. Active abduction and external rotation were measured at 1, 3, 6, 10, and 15 years and the results were analyzed statistically. Children with sequelae of C5-C6 palsy gained in abduction and external rotation more than children with C5-C6-C7 or complete palsy. Patients with mild preoperative shoulder dysfunction achieved the best results. The data showed the clinical results were related to the type of paralysis and to preoperative shoulder function, but not to age at surgery. They also showed progressive deterioration of abduction began at 6 years despite preserved active external rotation.

Adolescent↗
PubMed2005

The long-term clinical sequelae of incidental durotomy in lumbar disc surgery.

STUDY DESIGN: A retrospective, long-term follow-up study. OBJECTIVES: To find out whether incidental durotomy in lumbar disc surgery is associated with long-term sequelae. SUMMARY OF BACKGROUND DATA: Incidental durotomy is a frequent complication during spinal surgery. Little is known about the clinical long-term outcome. METHODS: The study population comprised 1,280 patients who underwent standard discectomy of a lumbar disc herniation. A total of 41 patients with incidental durotomies (Group A) were compared with a control group (n = 41) (Group B) matched for age, sex, spinal level, and duration of follow-up. After a mean follow-up period of 10.2 years (Group A) or 10.3 years (Group B), the patients reported complaints, headache, and low back or leg pain. The patients' activity was assessed by means of a questionnaire concerning hindrance in daily activities, the Tegner score for general activities in daily life, and the Hannover Functional Ability Questionnaire for Measuring Back Pain-Related Functional Limitations (FFbH-R). The frequency of reoperation and the intake of analgesics were included. Furthermore, the patients' inability to work, change of profession, and retirement were registered. RESULTS: Patients with incidental durotomy had a poorer outcome after surgery. The Tegner score was significantly decreased for the group with dural tears. Furthermore, significant more patients with incidental durotomy complained about headaches after surgery. A strong tendency for worse outcome in Group A was shown in regard to reported complaints and daily activity. The patients with incidental durotomy had a tendency to more reoperations, a longer duration of inability to work, more back-pain, and functional limitations related to back-pain (FFbH-R). CONCLUSION: Our study revealed that incidental durotomy in lumbar disc surgery was associated with long-term clinical sequelae. We therefore conclude that dural tears bring about poor clinical outcome at the long-term follow-up.

Absenteeism↗
PubMed2006

Orbital sequelae of rhinosinusitis after cochlear implantation in children.

OBJECTIVES: The objectives of this retrospective case review were to describe orbital complications in children after cochlear implantation, to define rhinosinusitis as a possible preoperative risk factor, and to suggest a possible pathophysiological mechanism for this previously unreported occurrence. METHODS: Records of children undergoing cochlear implantation over a 7-year period at a tertiary academic medical center were reviewed. Four children who experienced postoperative orbital sequelae were identified. We describe the demographics, clinical course, and radiologic findings in these children. RESULTS: The records of 91 children who underwent cochlear implantation were reviewed. The mean age was 6.0 years (range, 0.9-16.9 years). Forty-nine children (54%) were female and 51 (56%) were white. Four children developed postoperative orbital complications on the ipsilateral side to implantation. Orbital complications were characterized by periorbital edema and preseptal cellulitis necessitating prolonged hospitalization in all four children (mean length of stay, 3.3 days). Each child's orbital complication resolved with medical therapy that included intravenous antibiotics and nasal saline. Temporal bone images before implantation showed evidence of rhinosinusitis in all four cases. Of 76 available preoperative scans from the unaffected children, only 11 (14%) studies showed evidence of rhinosinusitis. CONCLUSIONS: Children with preoperative radiologic evidence of rhinosinusitis may be at risk of orbital sequelae after cochlear implantation. Positioning of the patient during surgery, length of surgery, and minor trauma to the lamina papyracea during drilling of the mastoid may be important etiologic factors. A careful review of medical history and computed tomography imaging before implantation may identify at-risk children.

Adolescent↗
PubMedDate not supplied

Relationship of self-reported asthma severity and urgent health care utilization to psychological sequelae of the September 11, 2001 terrorist attacks on the World Trade Center among New York City area residents.

OBJECTIVE: Posttraumatic psychological stress may be associated with increases in somatic illness, including asthma, but the impact of the psychological sequelae of the September 11, 2001 terrorist attacks on physical illness has not been well documented. The authors assessed the relationship between the psychological sequelae of the attacks and asthma symptom severity and the utilization of urgent health care services for asthma since September 11. MATERIALS AND METHODS: The authors performed a random digit dial telephone survey of adults in the New York City (NYC) metropolitan area 6 to 9 months after September 11, 2001. Two thousand seven hundred fifty-five demographically representative adults including 364 asthmatics were recruited. The authors assessed self-reported asthma symptom severity, emergency room (ER) visits, and unscheduled physician office visits for asthma since September 11. RESULTS: After adjustment for asthma measures before September 11, demographics, and event exposure in multivariate models posttraumatic stress disorder (PTSD) were a significant predictor of self-reported moderate-to-severe asthma symptoms (OR = 3.4; CI = 1.2-9.4), seeking care for asthma at an ER since September 11 (OR = 6.6; CI = 1.6-28.0), and unscheduled physician visits for asthma since September 11 (OR = 3.6; CI = 1.1-11.5). The number of PTSD symptoms was also significantly related to moderate-to-severe asthma symptoms and unscheduled physician visits since September 11. Neither a panic attack on September 11 nor depression since September 11 was an independent predictor of asthma severity or utilization in multivariate models after September 11. CONCLUSIONS: PTSD related to the September 11 terrorist attacks contributed to symptom severity and the utilization of urgent health care services among asthmatics in the NYC metropolitan area.

Adult↗
PubMed2004

Plantar burns in children: epidemiology and sequelae.

Pediatric plantar burns present with significant and unique characteristics. The treatment of choice remains controversial, and any alteration of the anatomy will lead to alteration in gait. To study the outcome of conservative treatment of plantar burns and determine risk factors, 40 pediatric patients affected with isolated plantar burns were studied. All burns were treated with silver sulfadiazine and early ambulation, and those that did not heal within 3 weeks were autografted. Twenty-eight patients (70%) had partial-thickness burns and 12 patients (30%) full-thickness burns. Complications during the acute period included 1 episode of cellulitis and 1 patient with prolonged difficulties with ambulation. Three patients required excision and autografting, and none of them developed late sequelae. Five patients presented with late sequelae, and all had in common complete healing with conservative treatment, young age, and a longer healing time (24.4 days). We conclude that conservative treatment of pediatric plantar burns has a negligible complication rate. Burns that do not heal within 3 weeks are best managed with excision and autografting, which had a 0% incidence of complication rate in this series.

Burns↗
PubMed2005

Psychological sequelae of medical and surgical abortion at 10-13 weeks gestation.

BACKGROUND: Although not much research comparing the emotional distress following medical and surgical abortion is available, few studies have compared psychological sequelae following both methods of abortion early in the first trimester of pregnancy. The aim of this review was to assess the psychological sequelae and emotional distress following medical and surgical abortion at 10-13 weeks gestation. METHODS: Partially randomized patient preference trial in a Scottish Teaching Hospital was conducted. The hospital anxiety and depression scales were used to assess emotional distress. Anxiety levels were also assessed using visual analog scales while semantic differential rating scales were used to measure self-esteem. A total of 368 women were randomized, while 77 entered the preference cohort. RESULTS: There were no significant differences in hospital anxiety and depression scales scores for anxiety or depression between the groups. Visual analog scales showed higher anxiety levels in women randomized to surgery prior to abortion (P < 0.0001), while women randomized to surgical treatment were less anxious after abortion (P < 0.0001). Semantic differential rating scores showed a fall in self-esteem in the randomized medical group compared to those undergoing surgery (P = 0.02). CONCLUSIONS: Medical abortion at 10-13 weeks is effective and does not increase psychological morbidity compared to surgical vacuum aspiration and hence should be made available to all women undergoing abortion at these gestations.

Abortifacient Agents↗
PubMed1993

Complications and late sequelae following nasotracheal intubation.

A total of 379 patients admitted to the ICU for mechanical ventilation were prospectively investigated for lesions on the nose, nasal cavity, ears and larynx during and after nasotracheal intubation. One to two years later, the surviving patients were questioned to investigate late persisting sequelae. During intubation and up to 5 days following extubation, inflammatory changes and ulceration of the nostrils or nasal septum were found in 76 (20%) and 110 patients (29%), respectively. There were bleedings from the nasal cavity in 67 (19%) and fractures of the conchae in 40 patients (11%). Hoarseness was noted in 135 patients (42%). Inflammatory changes and ulcerations of the nostril and nasal septum were correlated to the duration of intubation. Among the 281 patients included in the follow-up study, 100 (35%) had symptoms from the nose and nasal cavity. Sixty-five (24%) had symptoms related to the ears, 56 (20%) to the maxillary sinus, 81 (29%) to the voice and 90 (32%) to the throat. Increasing duration of intubation was found to be correlated to persisting symptoms from the larynx. Former ulcerations of the nose were associated with a tendency to nasal bleeding. To avoid as many complications as possible from the nose and nasal cavity, we recommend orotracheal intubation. As late sequelae from the larynx increase with the duration of intubation, perhaps tracheostomy should be performed earlier than is general practice today, but that has to be proven in forthcoming studies.

Adolescent↗
PubMedDate not supplied

Kawasaki disease with severe cardiac sequelae: lessons from recent New Zealand experience.

OBJECTIVES: To review recent cases of Kawasaki disease (KD) with significant cardiac sequelae in New Zealand. It is known that intravenous immunoglobulin (IVIG) reduces the risk of coronary artery aneurysm formation if given within 8-10 days of onset of KD. METHODS: Retrospective review of medical course, criteria for KD, laboratory and cardiac findings for six children identified with KD and significant coronary artery sequelae. RESULTS: There was delay in diagnosis of KD in three of the six children. Three cases were atypical by extremes of age (2 months, 10 years, 14 years). By definition all six children had significant coronary artery involvement. One patient had a thrombus detected in a coronary aneurysm 3 weeks after KD. One patient underwent coronary artery bypass grafting for unstable angina 2 years after KD. One patient developed coronary artery aneurysms after an initial 'toxic shock' type illness evolving to KD. Three patients died, one due to rupture of a coronary artery aneurysm, two from rapid early coronary artery obstruction occurring at three and 4 months after initial KD. CONCLUSIONS: Kawasaki disease remains an important cause of mortality and morbidity for children. Diagnostic delay beyond 8 days reduces the chances of successful IVIG therapy in KD. Current studies supported by the Paediatric Surveillance Unit should establish the epidemiology of KD in New Zealand.

Child↗
PubMed1994

Sequelae of radical prostatectomy.

OBJECTIVE: To evaluate the sequelae of radical prostatectomy, using a survey instrument. PATIENTS AND METHODS: Ninety-three consecutively treated patients who had undergone radical prostatectomy and who had been followed-up for between 12 and 48 months (mean 22.5) were sent a questionnaire by post. Of these, 86 (92%) completed and returned the questionnaire. The mean age of the patients at time of surgery was 64 years (range 49-75) and at time of follow-up was 66 years (range 50-77). RESULTS: Of the 86 patients who responded, 47% used a pad and 59% leaked urine daily. Thirty per cent dripped more than a few drops of urine daily and 34% found their incontinence bothersome. Eighty-four per cent of patients recalled that they had erectile potency before surgery. At follow-up, 9% were able to have a full erection and 38% were able to have a partial erection. Fifty-one per cent reported a substantial problem with reduced or absent erection. Twenty per cent had undergone treatment for bladder neck contracture and more than half of these had had more than one intervention. In all, 24% of the patients reported some persisting degree of physical unpleasantness which they believed to be secondary to their prostate cancer or the effects of treatment. Despite this, 74% were satisfied with their surgery and 88% said they would undergo surgery again. CONCLUSIONS: Using this survey instrument, we found adverse sequelae of radical prostatectomy to be surprisingly high. However, patients were generally satisfied with their decision to undergo surgery.

Aged↗