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PubMed2002

Urogenital atrophy: diagnosis, sequelae, and management.

It is estimated that 17% of our population will be over the age of 65 by the year 2030. As the body ages, many physiologic processes begin to decline. Health-care providers will need to be well-educated in the many sequelae of aging. Practitioners will especially need to focus on the health-care needs of women, since women have a longer life expectancy than men. Estrogen deprivation occurs in all women. Some will not have any symptoms, while others may experience all of its debilitating side effects: hot flashes, osteoporosis, insomnia, irritability, depression, and urogenital atrophy. Even though the latter is not life-threatening, it can alter a woman's quality of life considerably. Because it is easily treatable with minimal risk, all practitioners should become familiar with its presentation and management. This article discusses the many sequelae of urogenital atrophy: vulvovaginal irritation, urinary tract irritative symptoms and infection, urinary incontinence, and sexual dysfunction. Diagnosis and current management strategies are also discussed in detail.

Aged↗
PubMed2002

[Endoprosthesis of the knee joint in sequelae of tuberculous gonitis].

The paper analyzes endoprosthesis of the knee joint in sequelae of tuberculous gonitis in 19 patients and in 10 patients after nonspecific gonitis. The patients' age was 32 to 73 years. Clinically, all the patients third- and fourth-degree gonarthrosis with significant pain and a 15-25 degrees restriction of articular function. X-ray and computed tomographic data indicated destructive changes in the condyles of the femur and tibia, osteoporosis, cysts and cavities, these are typical residual sequelae of sustained tuberculous gonitis. In all cases, endoprosthesis of the knee joint was made by using Johnson-Johnson and Osteonix prostheses. Clinical and functional assessments showed that excellent and good results were obtained in 17 (58.6%) patients, satisfactory results were seen in 11 (37.9%). In one case there was a poor outcome with fibrous contracture of the knee joint after prior nonspecific gonitis with valgus deformity.

Adult↗
PubMed2002

Neuropsychological sequelae of adolescent infectious diseases.

This article discusses the neuropsychological sequelae of adolescent infectious diseases. Primary care physicians are encouraged to extend their clinical activities beyond the primary medical care aspects of the infectious disease process to encompass a comprehensive, multidisciplinary, continuum of health care approach. Patient, disease, and socioecologic parameters are the foundation of this approach. This article is designed to help primary care physicians appreciate the complexity of neuropsychological infectious disease issues in the adolescent. Human immunodeficiency virus 1 (HIV-1) is emphasized because the legion of related sequelae demands a comprehensive health care approach and serves as a model for discussing other principal infectious diseases such as encephalitis (particularly Lyme disease) and bacterial meningitis.

Adolescent↗
PubMed2003

Etiological analysis of the sequelae of radiotherapy for nasopharyngeal carcinoma: a follow-up study of 112 cases.

OBJECTIVE: To explore the etiology of the sequelae of radiotherapy for nasopharyngeal carcinoma (NPC) so as to find the possible means for reducing or preventing its occurrence. METHODS: A total of 112 pathologically confirmed patients with nasopharyngeal carcinoma, who had survived for 5 years following the radiotherapy, were included in this study. Sixty-four patients with the primary carcinoma in the nasopharyngeal region received radiotherapy with the radiation field covering the bilateral anterior ear regions, and in the other 48 patients, adjuvent exposure of the anterior nasal region was administered. The metastases in the cervical lymph nodes were exposed to tangential radiation by 40 Gy X-ray followed by approximately 20 Gy vertical electron beam exposure. RESULTS: Limited mouth-opening and dry mouth occurred mostly during the first 2 years after radiotherapy, and hearing loss in the first year. Neck fibrosis tended to increase with the time elapse after the therapy, and posterior cranial nerve damages showed no signs of time-related occurrence. It was found that the occurrence of neck fibrosis, dry mouth and the nerve injuries did not obviously correlate with the dosage of X-ray exposure in the anterior ear regions, while limited mouth-opening and the hearing loss increased with the radiation dosage. The sequelae did not arise from different radiation field selection as adopted in this study. CONCLUSION: The radiation dose should be controlled at around 70 Gy for NPC treatment, and for carcinoma remnant in the nasopharyngeal region, additional dose in the cavity would be appropriate. When the X-ray dose of 65 Gy in the neck region fails to result in satisfactory recession of lymph node metastasis, comprehensive treatment involving multiple modalities should be considered.

Adolescent↗
PubMed1994

Long-term neuropsychological sequelae of fever associated with amnesia.

It has been well established that high fever can cause substantial damage to the cerebellum and also cause multiple small vascular lesions in neocortex and subcortical white matter. Beyond acute effects, the neuropsychological sequelae of these latter cortical and subcortical lesions have not been studied. The investigation reported involved 36 VA patients with a history of serious febrile illness. The febrile illnesses of the pyrexic subjects did not cause febrile seizures and resulted from diseases that did not directly involve the brain (e.g., encephalitis, meningitis, malaria). Control subjects were combat veterans who had suffered gunshot wounds, but who had no history of febrile illness. Pyrexic patients performed worse than controls on a variety of measures including language, memory, concentration, and word finding as well as failing a test of dichotic listening for words. Results demonstrate that hyperpyrexia can have lasting neuropsychological sequelae, and suggest that history of serious febrile illness be considered as an exclusionary criterion for participation in neuropsychological research concerning other topics or disorders.

Journal Article↗
PubMed2004

Interleukin 1beta gene polymorphism association with severe renal manifestations and renal sequelae in Henoch-Schönlein purpura.

OBJECTIVE: To assess the influence of the interleukin (IL)-1beta gene (-511 C/T) in the incidence of Henoch-Schönlein purpura (HSP) and determine its possible implication in severe systemic complications of HSP, in particular severe renal involvement and permanent renal dysfunction (renal sequelae). METHODS: Patients from Northwest Spain with primary cutaneous vasculitis classified as HSP according to proposed criteria were studied. All patients were required to have had at least 2 years' followup. Patients and ethnically matched controls were genotyped for IL-1beta gene (-511 C/T) polymorphism by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). RESULTS: Forty-nine Caucasian patients (38 of them younger than 21 years) who fulfilled classification criteria for HSP and 148 controls were examined. No allele or genotype differences between the whole group of HSP and controls were observed. However, all 5 patients who developed severe nephropathy during the course of disease carried the rare T allele compared with only 16 of the remaining 44 patients (pcorr = 0.01). A significant association between carriage of the -511(IL-1beta) T allele and renal sequelae (pc = 0.02; OR: 3.6, 95% CI: 1.3-10.0) was also found. CONCLUSION: In unselected patients with cutaneous vasculitis who fulfill classification criteria for HSP, carriage of IL-1beta (-511) T allele appears to influence severity of renal involvement.

Adult↗
PubMed1992

Chronic erosions of the antral mucosa: a sequela of Helicobacter pylori-induced gastritis.

The etiopathogenesis of chronic erosions of the antral mucosa still remains to be clarified. In order to investigate the question as to whether chronic erosions might be a sequela of Helicobacter pylori-induced gastritis, we submitted biopsy material obtained from 250 patients with chronic erosions of the antral mucosa to a histological evaluation. The grading of Helicobacter pylori colonisation, and gastritis was compared with the results of histological evaluation of the biopsy material obtained from 1,196 patients with Helicobacter pylori gastritis, but no lesions of the gastric mucosa. The results of a histological analysis showed that Helicobacter pylori gastritis was present in 99.1 percent of the patients with chronic erosions of the antral mucosa. A comparison of the histological findings in patients with no lesions of the gastric mucosa revealed, that the density of Helicobacter pylori colonization, the severity of the antral gastritis together with its activity were statistically significantly more pronounced (p < 0.001) in patients with chronic erosions. In contrast, no differences in the morphological parameters were seen in the case of corpus mucosa. On the basis of these results, we conclude that chronic erosions of the antral mucosa represent a sequela of Helicobacter pylori gastritis, and that these Helicobacter pylori-induced chronic erosions should, in future, be differentiated from other erosions.

Adult↗
PubMed2003

[Diagnosis of trauma sequelae].

Traumatic events often trigger acute psychosomatic and psychiatric sequelae, which sometimes show a tendency to become chronic. The post-traumatic stress disorder (PTSD) is a complex syndrome with numerous mental and vegetative symptoms. The diagnosis of trauma sequelae requires a good knowledge of the differential diagnostically relevant comorbid conditions (e.g. anxiety disorders, depressive disorders, and somatoform disturbances). An appropriate management plan is possible only when suitable consideration is given to the traumatic genesis of symptoms. In the treatment of trauma, a stepped approach involving the principles stabilization, trauma processing and psychosocial re-integration has proven value.

Adolescent↗
PubMed1978

Segmental epidural analgesia and postpartum sequelae.

The incidence of the postpartum sequelae of headache, backache, pain in the legs and difficulties in micturiton, was studied in 219 normal vaginal deliveries. 135 of the parturients received continuous segmental epidural analgesia at the level of Th 10--12 for pain relief during the first stage of labour. The remaining 84 parturients served as controls. The results showed that segmental epidural analgesia did not increase the occurrence of postpartum sequelae either in primiparous or in multiparous parturients.

Adolescent↗
PubMedDate not supplied

[Neuropsychological sequelae of acute poisoning by pesticides containing cholinesterase inhibitors].

In recent years a number of studies have drawn attention to the possible neuropsychological sequelae stemming from acute poisoning by certain substances, namely cholinesterase inhibitors. These chemicals, carbamates and organophosphorates (OP), have been used in industry, for washing cattle, as insecticides and even as chemical agents in terrorist attacks and in wars. Nowadays, they are widely used as a pesticide and this is particularly so in regions such as the west of Almeria. The intensive farming in greenhouses carried out in this area, together with the conditions in which these products are used and handled, leads to a relatively high number of cases of poisoning. Yet this is not an isolated fact; the first clinical study to describe cases of poisoning by these substances in workers was published back in 1955. Some of the neurotoxic sequelae deriving from such intoxications are well defined: acute cholinergic syndrome, intermediate syndrome and delayed polyneuropathy provoked by OP (OPIDN). Several studies have been carried out over the past few decades to measure the long term neuropsychological disorders produced by acute poisoning by these substances, and findings suggest that both cholinesterase inhibition and other biochemical phenomena can have permanent neurotoxic consequences. This communication aims to bring some order to the data offered by the different studies by analysing and verifying the evaluation protocols followed, the results of the neurophysiological and neurocognitive biochemical measurements, the type of poisoning and the time elapsed since they occurred, so that they can be summarised and taken as guidelines for possible work to be carried out in the future.

Animals↗
PubMed1992

[Hyperbaric oxygen for neuropsychiatric sequelae of carbon monoxide poisoning].

A broad range of neuropsychiatric abnormalities, including dementia, psychosis, and parkinsonism, as well as almost every known neurologic syndrome, can occur following carbon monoxide (CO) poisoning. These symptoms develop 2-40 days (usually 2-3 weeks), after initial exposure. There is an incidence of recurrence of up to 40%. However, in recent years the neuropsychiatric sequelae appear to have been occurring less frequently, perhaps as a direct result of the use of hyperbaric oxygen (HBO) therapy. There is no specific therapy for this complication, but up to 75% recover within 12-18 months. Myers et al. (Ann Emerg Med, 14: 1163, 1985) found HBO to be effective for the neuropsychiatric sequelae. We report a 19-year-old man who developed late psychiatric disturbances despite the use of HBO for acute CO intoxication. The neuropsychiatric symptoms, which developed 3 days after full recovery of consciousness, resolved completely when HBO therapy was reinstituted. 6 months later he was functioning normally with no neuropsychiatric symptoms.

Adult↗
PubMed1992

[Complications and sequelae of benign thyroid surgery].

A series of 640-operations performed on benign thyroid gland during 8 years is presented. The pre and post operative mortality is 0.62 per cent. Late recurrent nerve paralysis occurred in 2.6 per cent. 27 patients had transit hypocalcemia and 8 had permanent hypoparathyroidism or 1.2 per cent. These complications has been studied in relation with patient benign thyroid affection and operation. In case of thyroidectomy without search for recurrent laryngeal nerve, nervous paralysis are frequent when if parathyroid gland are rare, for these lata are protected. Systematic dissection of recurrent nerve reduce nervous sequelae, but increase hypoparathyroidism, mainly by devascularisation of parathyroids glands. Complications and sequelae of thyroid surgery can yet be reduced by a rigorous surgical technic, a most sure experience and a systematic dissection of recurrent nerve and gland parathyroid in case of bilateral operation.

Female↗
PubMed1992

[P300 latency in patients with respiratory insufficiency due to sequelae of pulmonary tuberculosis].

We studied latent (mild) pulmonary encephalopathy in 14 patients with mild chronic respiratory insufficiency due to the sequelae of pulmonary tuberculosis. All of the patients were between 49 and 62 (mean age: 57.9). None of them had any impairment of daily activities and apparently had a clear consciousness. First, the P300 component evoked by auditory stimuli was examined. Immediately after that, the PO2, PCO2, pH were measured. Then the Hasegawa's dementia scale, the mini-mental state, the "Kanahiroi" test, Zung's depression score, digit span test were also assessed in the 14 patients. P300 components in 7 age-matched normal volunteers were also examined and compared with those in the 14 patients. The mean P300 latency in the patients were significantly prolonged compared with that in the normal volunteers (p less than 0.01). The P300 latency was well correlated with the PCO2, PO2, pH. The results of the "Kanahiroi" test also correlated with these parameters. We suggest that patients with mild respiratory insufficiency due to the sequelae of pulmonary tuberculosis often have latent (mild) pulmonary encephalopathy, and that P300 latency and the "Kanahiroi" test are very useful to detect and evaluate such latent pulmonary encephalopathy.

Aged↗
PubMed2004

Predictors and sequelae of fractures in the elderly: the Canadian Study of Health and Aging (CSHA).

The objective of this study was to describe the incidence, type, risk factors, and sequelae of fractures experienced by community-dwelling elderly Canadians. Data are from the Canadian Study of Health and Aging (CSHA), a longitudinal cohort study, collected in three waves: baseline (1991), wave 2 (1996), and wave 3 (2001). In CSHA-2 (1996), fractures were reported by 3.7 per cent of men and 7.5 per cent of women; in CSHA-3 (2001), by 2.9 per cent of men and 7.3 per cent of women. The distribution of fracture types was similar for men and women. Risk factors for women were increased age, history of fracture, and regular alcohol use; for men, stroke, arthritis, and lack of independent bathing. Walkers or wheelchairs were needed by over 30 per cent of those with any lower body fracture. One third of subjects with any fracture and over 50 per cent with femur fractures reported moderate or severe pain. It is concluded that elderly Canadians are at high risk for fractures, and older women are at most risk. Pain and mobility problems were common sequelae. The need for primary and secondary prevention of these age-related events is paramount.

Aged↗
PubMed1992

[The sequelae of osteoporotic femoral fracture in Barcelona].

BACKGROUND: The aim of the present was to study the long term sequelae of osteoporotic fracture of the femur in a general hospital of 300 beds in Barcelona, analyzing 1) mortality; 2) degree of functional capacity; 3) care requirements; 4) familial repercussion, and 5) psychic repercussion. METHODS: Structured telephone interviews were carried out between 1990-1991 with the patients attended for osteoporotic fracture of the femur in our center from 1988-1989. Of a total of 145 patients, 12 died within 1 month. Among the remaining patients the interview was performed with 100 patients--25 of whom were males of 78 +/- 8 years of age and 75 females of 82 +/- 10 years of age. The degree of functional capacity was evaluated by the index of independence in daily activities (DA). RESULTS: Mortality within one month was 8.3%; at one year 30% and at 2 years 38%. Factors associated with the highest mortality were: age of over 80 years (p less than 0.004), deterioration of post fracture functional capacity (p less than 0.0004) and pre-fracture dementia (p less than 0.01). Important deterioration in post fracture functional capacity was seen in 45% of the cases. Seventeen percent of the patients required transfer to a center for chronic care and 34% resided in a center for chronic care prior to the fracture. Familial repercussion was observed in 43% of the cases and post fracture psychologic repercussion was seen in 28%. CONCLUSIONS: Osteoporotic fracture of the femur presents the following sequelae: mortality, intense deterioration of functional capacity and important health care requirements in addition to considerable familial and psychological repercussion.

Activities of Daily Living↗
PubMed2005

[Less severe sexual child abuse and its sequelae: are there different psychic and psychosomatic symptoms in relation to various forms of sexual interaction?].

A typology of less severe sexual encounters was used to analyze short and long term sequelae of sexual abuse via intimate skin contact. Well known theoretical approaches on the harmful effects of sexual abuse were tested. Do we find different peri- and posttraumatic reactions dependent upon varied forms of sexual interactions with children? A cluster analysis was calculated with symptom variables that were described in 141 child statements taken out of written expert opinions. Afterwards variance analyses of these symptom clusters were conducted in reference to six different abuse constellations. Different symptom profiles were found for these six abuse constellations. Panic symptoms, shame related feelings, avoidant behavior and physical reactions showed significant results. The sequelae to different forms of less severe sexual child abuse differ and depend more upon the situational dynamic than upon the kind of relationship between adult and child.

Anxiety Disorders↗
PubMedDate not supplied

One-year sequelae in patients with West Nile Virus encephalitis and meningitis in Louisiana.

West Nile Virus (WNV) infection can be severe and complicated by neuroinvasive disease, such as meningitis and encephalitis. Not much is known about the one-year sequelae following a complicated WNV infection. From July to December 2002, the first large outbreak of WNV in the Southern United States occurred in Louisiana. This epidemic resulted in 329 cases of WNV infection including 125 cases of West Nile fever and 204 cases complicated by meningitis and encephalitis. One year later, during the fall of 2003, a telephone survey was conducted to understand the one-year effects of severe WNV infections. WNV case fatality rate was 19.6%. Death certificates of all the deceased were reviewed to verify the mortality rate from WNV infection. The telephone survey revealed that one-year sequelae from severe WNV infections are common and can affect the body and mind. In addition, it can change a person's perception of the state of their health.

Adolescent↗
PubMed2005

[Neurological late sequelae in twins born after in vitro fertilisation--secondary publication. A national cohort study].

Currently 4% of the Danish national birth cohort is born after in vitro fertilisation techniques and almost 40% of these children are twins. In this register-based national cohort study, twins from assisted conception (n = 3393) had a similar risk of neurological sequelae and cerebral palsy as their naturally conceived peers (n = 10.239) and assisted conceived singletons (n = 5130). Further children born after intracytoplasmic sperm injection (ICSI) had the same risk of neurological sequelae as children born after conventional IVF.

Adult↗