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PubMed1994

[Complications and late sequelae after nasotracheal intubation].

A total of 379 patients admitted to the Intensive Care Unit (ICU) for mechanical ventilation were prospectively investigated for lesions of 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 five days following extubation, inflammatory changes and ulceration of the nostrils or nasal septum were found in respectively 76 (20%) and 110 (29%) patients. 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 toward 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↗
PubMed1994

Aftermath of a chemical spill: psychological and physiological sequelae.

Psychological, and psychophysiological sequelae were studied in a community which had experienced a railroad chemical spill of 19,000 gallons of the toxic pesticide metam sodium. Information was collected on 350 persons living in the area of the spill (spill residents) and 114 nonexposed controls, recruited using a randomized sampling strategy, from a nearby similar, but unexposed control town. Psychological measures used were the MMPI-2, POMS, IES Scale, Environmental Worry, Perceived Social Support and Perceived Control Scale. Physiological measurements were two measurements of blood pressure, pulse, and salivary cortisol level, taken both at the beginning and the conclusion of the study. Demographic and medical information was asked in a Questionnaire. Results indicate greater levels of depression, anxiety, and somatic symptoms in the spill residents in addition to greater environmental worry and lower perceived social support. Spill odor perception was related to increased psychological and physiological sequelae. The spill residents had higher blood pressure and less fluctuation of cortisol levels than the controls. Comparison of spill residents who were litigants and those who were not, indicates no differences for blood pressure, pulse, and cortisol, MMPI-2, Environmental Worry and the Control Scale. Litigants scored slightly higher on the IES, Intrusion and the POMS scales. No dose/response relationship between distance to the river and evacuation status was obtained. The chemical spills was associated with a wide variety of psychological and physiological reactions.

Adult↗
PubMed1994

[Osseous stable functional osteosynthesis in the sequelae of bone and joint diseases and injuries].

The method of osteosynthesis association was applied in 1,000 patients with sequelae of diseases and injuries of large joints and bones of the limbs. The results show that stable-functional osteosynthesis with compression plates is a very effective modern method of surgical treatment of patients with serious sequelae of injuries and diseases of the epi-meta-diaphyseal parts of the bone and must be used more extensively in practice.

Adolescent↗
PubMed1994

[Haemophilus influenzae meningitis 1983 to 1992--epidemiology and sequelae of the disease].

During the ten-year period 1983-1992 40 children (16 girls and 24 boys) were treated for pyogenic meningitis caused by Haemophilus influenzae type b (Hib). The incidence was 1 case per year out of 5500 children younger than 6 years of age. The youngest child was 5.5 months old, 8 children (20%) were younger than 12 months. The highest incidence was during the second year of life (16 patients). The oldest patient was 11.5 years old. The course of Hib meningitis varied. The disease ran a fulminant course in 10 children. In 9 patients the symptoms evolved more gradually over a period of more than 48 hours, whereby 4 of these patients were only slightly ill on admission. Treatment until 1987 consisted of a combination of ampicillin and chloramphenicol, thereafter cetriaxon and ampicillin were used. Two patients died. One child was left with devastating handicaps and 5 children suffer from minor, but persisting sequelae (seizure disorder, delay in psychomotor development, attention deficit hyperactivity disorder, learning problems, speech delay). Transient disorders were found in 8 patients (EEG abnormalities, delay in psychomotor development, transient hearing problems). Severe hearing loss was seen in only one patient. 24 children (60% of all cases) recovered without any sequelae. Our results, in accordance with the literature, show that in spite of prompt availability of medical assistance, potent antibodies and a high standard of hospital care, the mortality and morbidity following Hib meningitis are still unacceptably high. Hence, we emphasize the need to eliminate Hib infection by immunization programmes.

Ampicillin↗
PubMed1993

Specific sequelae after Fontan operation at mid- and long-term follow-up. Arrhythmia, liver dysfunction, and coagulation disorders.

Patients who have undergone a Fontan-type operation usually have an elevated systemic venous pressure. To determine the sequelae of this nonphysiologic condition, we evaluated 66 patients 1 to 14 years after a Fontan-type operation. Fifty-one patients were apparently in good clinical condition, and 15 patients had symptoms and were restricted in their daily life. Bicycle exercise capacity, tested in 41 patients, ranged from 50% to 110% (mean 85%) of the predicted value for length. In 16 patients, a decreased capacity (< 85%) was, among others, related to arrhythmias and the presence of protein-losing enteropathy. A 24-hour ambulatory electrocardiogram was available in 56 patients and found to be normal in 32 (57%) patients. Arrhythmias were present in 21 patients, six of whom had symptoms. Three patients had previous pacemaker implantation. One or more abnormalities in liver enzyme and function tests were present in 40 patients (61%) and in coagulation factors in 46 patients (69%). The most pronounced was a protein C deficiency, a known thrombotic risk factor, present in 41 patients. The occurrence of arrhythmias increased with time of follow-up (p < 0.004), the occurrence of protein C deficiency decreased with time (p < 0.0001), and the occurrence of abnormal liver enzyme and function tests was not related to time of follow-up. With regard to age at operation, arrhythmias did not occur in patients who underwent operation at a mean age of 4 +/- 1.9 years (standard deviation), in contrast to patients who underwent operation at a mean age of 7.6 +/- 4 years (standard deviation) (p < 0.001). The occurrence of the two other types of sequelae was not related to the age at operation. With regard to the type of operation, only patients with a valved right atrium-to-pulmonary artery connection had a higher prevalence of arrhythmias than patients with a nonvalved or direct right atrium-to-pulmonary artery connection (p < or = 0.001). The latter patients also had a higher prevalence of protein C deficiency (p < or = 0.001). No relationship was found among the other types of operation, the underlying structure, or the hemodynamic condition measured at rest and the presence of arrhythmias, abnormal liver enzyme and function tests, or protein C deficiency. This point survey shows that even patients with an apparently good clinical condition are at risk for arrhythmias, abnormal liver enzyme and function tests, and coagulation factor abnormalities. Serial statement of affairs is recommended to ensure that adequate preventive measures can be taken.

Adolescent↗
PubMedDate not supplied

Prevention of auditory sequelae in pediatric bacterial meningitis: a meta-analysis.

Meta-analysis methods were used to compare the effect of antibiotic regimens and corticosteroids on the development of auditory sequelae after pediatric bacterial meningitis. After a literature search of two major data bases, 11 studies met the criteria and were included in the analysis. Summary odds ratios, with 95% confidence intervals, were calculated that quantified the relative risk of developing auditory sequelae after specific therapies. No significant differences among antibiotics were identified in terms of reducing the risk of meningitis-related hearing impairment. However, corticosteroids significantly reduced the frequency of bilateral, moderate, or greater hearing loss. Patients receiving placebo versus dexamethasone were much more likely to develop auditory dysfunction (odds ratio 3.77; 95% CI 1.77-8.10). The results of this study add quantitative evidence supporting the use of dexamethasone as adjunctive therapy in pediatric bacterial meningitis.

Adrenal Cortex Hormones↗
PubMed1976

[Late sequelae and complications in exclusive high voltage radiotherapy for carcinoma of the cervix uteri (author's transl)].

This study deals with 524 cases of uterine cervix (except stade IV cases) completely treated at the Foundation Curie with esclusive radiotherapy from from 1962 to 1968. The irradiation techniques, as well as the doses given to the tumor and to the critical organs are stated. The various sequelae and complications are described, according to the class and severity. The cases are divided into two groups: 257 cured patients and 267 dead patients. For the cured patients, half of them (49%) had no trouble at all. Among the 130 remaning cases, 16% presented with mild troubles, 23% with moderate sequelae, 9% with marked complications and 3% with severe complications leading to an infirmity. The rectal troubles are frequent (55% of all the troubles) in 40% of the patients; though rarely, they can be severe (6% of the cases). They appear relatively early. The bladder troubles rank second (37% of all the troubles) in 20% of the patients; never severe and without any renal effect, they are more delayed than the former. The skin and soft tissues troubles are only a few (5%) for 5% of the patients. They are mostly mild and moderate. One skin necrosis was noted due for a large part to the very poor general conditions of the patient. The bone troubles are always classified here as marked or severe; they are rare (2,6%) in 2,3% of the patients. Their treatment is satisfactory. One single case of bilateral femur neck fracture gave a permanent infirmity. We have noted no nervous trouble, nor urinary trouble other than the bladder ones, nor bowel troubles aprt from a mild and transient sigmoiditis. The genital troubles noted in 21% of the patients are mostly vaginal adhesion in women over 60 years of age. The sexual troubles, very difficult to analyse, have not been studied here. The treatments of these various troubles have generally been simple, not very compelling, and effective. Only eight patients with severe complications (3%) underwent important therapeutics (fecal diversion, none surgery) and kept an infirmity. One patient (0,4%) died during the post-operative course. For the dead patients, the study is less significant, because of the neoplastic evolution and of the rather short survival. This fact explains that 20% only of the patients (versus 51%) presented with 106 troubles (versus 304). The rectal troubles remain frequent 33%) of the cases), though the bladder troubles, more delayed, are very less numerous (1,8% of the patients). The bone complications are similar in number and quality (2,2% of the patients).

Adult↗
PubMed1994

[Morbidity, mortality and late sequelae in extremely premature infants born in the Hvidovre Hospital, 1985-1991].

In the period 1985 to 1991, 80 infants with gestational age below 28 completed weeks were born at Hvidovre Hospital, Copenhagen and transferred to the neonatal intensive care unit of the hospital. The incidence of extreme prematurity was 3.6 0/00. Twenty-eight infants died during the neonatal period (35%) and nine infants died later in infancy (11.3%). Forty-three infants (54%) survived. Forty four percent of surviving infants had one or more sequelae related to their prematurity or neonatal complications, mainly blindness or reduced vision, cerebral palsy and mental retardation. Neither gender, mode of delivery or birth asphyxia were important for survival and sequels. Neonatal complications such as patent ductus arteriosus, septicaemia, necrotizing enterocolitis, pneumothorax and cerebral haemorrhages were significantly related to survival and sequelae.

Birth Weight↗
PubMed1993

[Psychological sequelae of accidents. Symptoms are seldom recognized].

OBJECTIVE: To present the problems possibly associated with psychological sequelae of accidents and make proposals for appropriate therapy. MAJOR POINTS: Accidents experienced by the victim as threatening, whether associated with immediate physical or mental impairment or not, often trigger multiple psychological reactions, and may lead to psychological disorders of either a temporary or a permanent nature. Accident-related psychological symptoms or problems are almost regularly overlooked during the acute medical treatment phase. Not until psychological symptoms become evident are psycho-diagnostic and therapeutic measures undertaken. If such psychological problems, which may often manifest in physical symptoms or behavioral changes, are not recognized early on and vigorously treated, recovery of the patient may be appreciably impaired. CONCLUSIONS: The care-providing physician should expect psychological accident sequelae and give consideration to them in his overall treatment plan.

Accidents↗
PubMed1993

Neuropsychological sequelae of cardiac arrest.

OBJECTIVES: Prospective and community-based studies on the cognitive outcome of out-of-hospital cardiac arrest have not been published. We studied prospectively the neuropsychological sequelae of cardiac arrest and evaluated the effects of nimodipine on them. DESIGN: Placebo-controlled, randomized, double-blind trial of nimodipine compared with placebo in out-of-hospital ventricular fibrillation. SETTING: Urban area of 500,000 inhabitants served by the physician-manned Advanced Life Support Unit of Helsinki. PATIENTS: A total of 155 successfully resuscitated consecutive patients out of 677 resuscitation attempts during 2 1/2 years. Sixty-eight survivors were examined by a neuropsychologist and a neurologist. MAIN OUTCOME MEASURE: Neuropsychological outcome 3 months and 1 year after cardiac arrest. INTERVENTIONS: Nimodipine or placebo at a dosage of 10 micrograms/kg as an intravenous injection immediately after restoration of spontaneous circulation, followed by an infusion of 0.5 micrograms/kg per minute for 24 hours. RESULTS: Three months after cardiac arrest, 41 (60%) of 68 patients were found to have moderate to severe cognitive deficits. At 12 months, 26 (48%) of 54 survivors still had moderate to severe deficits, and the Symptom Check List 90--Revised score indicated the presence of depression in 22 patients (45%) and severe depression in 12 patients (24%). CONCLUSIONS: Moderate to severe neuropsychological sequelae of out-of-hospital cardiac arrest are still present in approximately one half of the survivors at 1 year and may be permanent. There seems to be no excess of increased disability in the subgroup of patients with delayed advanced life support. Nimodipine failed to show any effect on the cognitive functions tested.

Adult↗
PubMed1993

[The functional sequelae of Mycoplasma pneumoniae pneumonia].

To check the possible existence of long-term pulmonary functional sequelae in patients with pneumonia due to Mycoplasma pneumoniae, 17 patients who showed evident spirometric disorders during the recovery from the acute phase of a pneumonia due to Mycoplasma pneumoniae were studied. In the acute phase of the disease, 7 patients showed a ventilatory restriction, 6 of them had an obstructive pattern while in four patients a mixed pattern was observed. After a latency period, which mean length was 39 months, it was seen that there was a return to normal values of the spirometric conventional parameters initially altered in all cases. However 5 patients (33%) who did not smoke, showed a significant decrease on the maximum flows at low volume. These results suggest that in a high percentage of adult patients, as has been previously described in children, pneumonia due to M. pneumoniae could leave as a sequelae the persistent affectation of small airway.

Adolescent↗
PubMed1995

[Sequelae in the knee extensor system following graft removal for the "Mac in Jones" type procedure].

PURPOSE OF STUDY: The aim of this study was to evaluate clinical and radiological sequelae following removal of part of the patellar tendon for A.C.L. reconstruction. MATERIALS AND METHODS: A consecutive and homogenous series of 100 patients operated for chronic anterior instability (66 men, 34 women; age 16 to 55 years, average: 28.5 years) was studied. The procedure involved a free patellar tendon graft harvested from the mid third of the tendon and including its bony attachments, and in particular a long strip from the patella and a strip 10 centimeters long from the rectus femoris tendon for extra-articular reconstruction. Tendon graft sites were closed. Patellae and tibial tunnels were filled with bone debris from the drilling, and the pre-patellar fascia was closed. The mean follow-up period was 35 months. pain and radiological alterations (with pre-operative X-rays as reference) were studied, particularly for: calcifications, patellar height changes using the Insall, Blackburne and Caton methods, increase in patella tip length, femoro-patellar joint alteration. RESULTS: Calcification were found in: quadriceps tendon: 24 per cent of cases (always painless), Pre-patellar: 16 per cent of cases (usually less than 5 mm), Superior patellar tendon: 47 per cent of cases (only 2 cases being painful, no unaffected tendons were painful), Inferior patellar tendon: 7 per cent of cases (1 in the mid), Tibia tunnel: 26 per cent of cases. No cases required surgical removal. Patellar tip length did not increased significantly. Patellar tendon length decreased by 1.37 mm. Patellar height measured by the Insall, Blackburne and Caton methods was not significantly affected. The femoro-patellar joint was normal in 95 per cent of cases. There were five cases of remodelling, one being painful. CONCLUSION: Graft harvested from the extension system for A.C.L. reconstruction frequently resulted in radiological sequelae but were usually asymptomatic. In most cases these calcifications concerned the superior patellar tendon, quadricipital tendon and pre-patellar zone. Patella height was not affected.

Adolescent↗
PubMed1995

[Long-term study of patients with pulmonary tuberculosis sequelae after bilateral thoracoplasty-airway obstruction and its causes].

Chest roentgenograms and results of pulmonary-function tests in patients with pulmonary tuberculosis sequelae 30 years after bilateral thoracoplasty were studied retrospectively to detect airway obstruction in these patients and to determine its causes. For periods of more than 10 years, vital capacity (VC) changed at a rate of 15.5 +/- 5.0 ml/year, and forced expiratory volume in one second as a percent of VC (FEV1%) changed at a rate of 0.546% +/- 0.380% per year (n = 13). Thirty years after thoracoplasty, the VC was 920 +/- 180 ml (%VC = 28.4% +/- 5.3%), and the FEV1% was 66.2% +/- 13.7% (n = 21). Thus, mild airway obstruction was found in about half of the cases. For each patient, the distance from the hilum to the diaphragm was measured along the mid-clavicular line on the side with fewer ribs resected, and this distance was divided by the patient's height. The results of that computation was found to be significantly and negatively related to FEV1% (r = -0.681, which suggests that longer bronchi in the lower and middle lobes on that side were associated with lower values of FEV1%. These findings are similar to those in patients with pulmonary tuberculous sequelae after total pneumonectomy. Over an average of 26 years, scoliosis, the vertebra showing the most bending, the intrapulmonary lesion, and the position of the diaphragm did not change, but the cardio-thoracic ratio increased.

Adult↗
PubMed1995

Fibrous dysplasia of the temporal bone: ten new cases demonstrating the spectrum of otologic sequelae.

monostotic. Although most patients had a conductive hearing loss, 17% of patients demonstrated profound sensorineural hearing loss ascribable to the lesion, and facial nerve sequelae were noted in nearly 10% of cases. Cholesteatoma complicated almost 40% of cases, usually in the form of a canal cholesteatoma. Ten new cases of temporal bone fibrous dysplasia are described not only to further clarify the spectrum of otologic sequelae but also to help illustrate available treatment options. In addition, this report documents, in three new cases, the previously undescribed progression of conductive hearing loss to profound sensorineural deafness secondary to fibrous dysplasia.

Adolescent↗
PubMed1995

The etiology and management of acute and late sequelae of radiation therapy in persons with head and neck cancers.

Radiation therapy is an important primary modality in the treatment of cancers of the head and neck. Persons with advanced cancers often receive combined-modality treatment with concomitant radiation and chemotherapy. The sequelae of radiation alone and that of combined therapies create an extremely vulnerable individual. The nurse caring for the person receiving cancer treatment must understand the effect of radiation on normal tissues of the head and neck region and the methods designed to ameliorate the sequelae of therapy.

Acute Disease↗
PubMed1996

[Relation of pulmonary hemodynamics and ventilation to tissue hypoxia during exercise in patients with tuberculosis sequelae].

We examined a relationship between tissue hypoxia and pulmonary hemodynamics or ventilatory capacity during rest and exercise in patients with tuberculosis sequelae. Nine patients performed exercise test until their symptom limit. Mean pulmonary arterial pressure (PPA) during exercise was plotted against cardiac index (C.I.) from rest to maximum exercise in each patient. In most of the patients, the changes of PPA showed linear relation with the C.I., and a slope (P-F slope) was obtained from the regression equation in each patient, and it was used as an index of circulatory disability during exercise. At the same time a coefficient of oxygen delivery (COD) was calculated and mixed venous oxygen tension (PvO2) was measured to evaluate a tissue hypoxia at rest and during exercise. The changes of COD were similar to those of PvO2 during exercise. COD positively correlated with PvO2 (R = 0.873, P < 0.01) from rest to maximal exercise, indicating that the values of PvO2 depended on those of COD. P-F slope negatively correlated with S.I. (R = -0.887, P < 0.01), oxygen transport (R = -0.780, P < 0.01), COD (R = -0.827, P < 0.01) and PvO2 (R = -0.760, P < 0.01) at maximal exercise. Whereas no significant relationship between ventilatory variables and COD or PvO2 was noted at maximal exercise. In conclusion, the patients with pulmonary tuberculosis sequelae who had a step P-F slope showed low mixed venous oxygen tension during exercise as a result of limited oxygen transport in consequence of low stroke volume.

Cell Hypoxia↗
PubMed1995

Long-term pulmonary sequelae after autologous bone marrow transplantation in children without total body irradiation.

We investigated the long-term pulmonary sequelae of 38 children surviving 3 to 11.5 years (median 7 years) after high-dose chemotherapy (HDC) and autologous bone marrow transplantation (ABMT) without TBI. This cross-sectional study included patients with neuroblastoma (21), non-Hodgkin's lymphoma (7), Ewing's sarcoma (5), rhabdomyosarcoma (3), medulloblastoma (1) and ALL (1). They were asked and examined for clinical signs and underwent a physical examination with chest X-ray; 33/38 had pulmonary function tests (PFT) performed. No obstructive disease was found. Fifteen out of 32 evaluable PFT (47%) were abnormal with a pulmonary restrictive syndrome in 10, and borderline values in five patients. Four of these 15 patients were symptomatic with exertional dyspnea and two of four had abnormal chest X-rays. The etiology was mainly multifactorial, associating HDC with thoracic radiotherapy +/- scoliosis/kyphosis +/- previous thoracotomy +/- post-ABMT interstitial pneumonitis. Only 3/10 patients with a restrictive syndrome had HDC containing BCNU or busulfan as the only risk factor for lung disease. We conclude that the prevalence of late pulmonary sequelae after ABMT without TBI is moderate and rarely due to HDC alone, since most abnormal PFT can be explained by heavy pretreatment prior to ABMT. As symptoms are scarce even in advanced disease, repeated testing and very long-term follow-up are needed.

Adolescent↗
PubMed1996

[Diagnosis of pulmonary aspergillosis in cases with cavity as sequela of tuberculosis].

Non-invasive pulmonary aspergillosis is frequently seen in cases with cavity as sequela of tuberculosis. Diagnosis of non-invasive pulmonary aspergillosis is not easy except for cases whose chest X-ray findings show a typical fungus ball. How to diagnose pulmonary aspergillosis was studied in 21 patients who showed changes in the radiological findings of cavity as sequela of tuberculosis. We made sputum culture of Aspergillus, measurement of precipitin antibody titer to Aspergillus fumigatus and measurement of PASTOREX ASPERGILLUS in serum and sputum on the 21 patients (group A). PASTOREX ASPERGILLUS in sputum was evaluated in three grades: 1+ approximately 3+. We diagnosed 14 patients as pulmonary aspergillosis (PA group) among the 21 patients taking into account the chest X-ray findings and the results of the above-stated investigations. The types of chest X-ray findings of these 14 patients were fungus ball type (FB) in 2 patients, productive aspergilloma on the inner wall of a cavity (PAIC) in 8, mixed type with FB and PAIC in 2 and non-specific change in 2. However, there were 3 patients with the chest X-ray findings suggestive of PAIC in 7 patients (non-PA group) who were not diagnosed as pulmonary aspergillosis. Sputum culture were positive in 11 patients of PA group (79%) and negative in all patients of non-PA group. Precipitin antibody were positive in 8 patients of PA group (67%) and negative in all patients of non-PA group. PASTOREX ASPERGILLUS in serum were negative in all 21 patients. PASTOREX ASPERGILLUS in sputum were 3+ (+3) in all 14 patients of PA group and in 2 patients of non-PA group and 2+ (+2) in 2 patients of non-PA group. 12 patients of PA group were treated by antifungal agents and 11 patients responded well to the treatment. We also made sputum culture of Aspergillus and measurement of PASTOREX ASPERGILLUS in sputum on 14 patients (group B) who had respiratory diseases with stable cavities and 17 patients (group C) who had respiratory diseases without a cavity. In group B, sputum culture were positive in 1 patient and PASTOREX ASPERGILLUS in sputum were 3+ (+3) in 2 patients, 2+ (+2) in 1 and 1+ (+) in 2. In group C, sputum culture were negative in all patients and PASTOREX ASPERGILLUS in sputum were 3+ (+3) in 1 patient, 2+ (+2) in 3 and 1+ (+) in 2. Measurement of PASTOREX in sputum was a useful tool to diagnose non-invasive aspergillosis in addition to sputum culture and measurement of precipitin antibody titer. The sensitivity of PASTOREX in sputum was high but its specificity was low, however, its specificity could be raised by applying semi-quantitative analysis of PASTOREX in sputum.

Adult↗