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PubMed1996

Pathophysiologic sequelae of intracranial disease.

A variety of intracranial diseases affect dogs and cats. Clinical signs often result not only from mechanical destruction of normal brain but also from associated pathophysiologic alterations induced secondary to the primary disease process. Effective management of intracranial disease requires recognition and treatment of the primary as well as of many of these secondary pathophysiologic sequelae. This article discusses the evolution, ramifications, diagnosis, and treatment of these pathophysiologic sequelae.

Animals↗
PubMed1997

Epidemic heat stroke in a midwest community: risk factors, neurological complications and sequelae.

We studied the admission rate, risk factors, neurological complications and sequelae of heat stroke (HS) during the 1995 heat wave in Madison, Wisconsin. HS was epidemic in 1995 (2.3 cases/1000 admissions), compared to the ten-fold lower endemic rate in 1994 (0.2/ 1000). There were 11 cases of HS, 9 males and 2 females. Contributing factors were athletic events (2), working outdoors (3) and indoor activity with malfunctioning air-conditioning (6). Medical conditions contributing to poor temperature regulation included schizophrenia with neuroleptic treatment (2), amyotrophic lateral sclerosis receiving nortriptiline (1), multiple sclerosis (1), attention deficit disorder (1), cystic fibrosis (1) and alcoholism (1). Acute neurological complications occurred in all patients on presentation including coma (8/11.73%), stupor (2/ 11.18%) and seizures (1/11.9%). Two patients (1856) had persistent neurological sequelae in the form of a pan-cerebellar syndrome while the remaining 9 recovered fully. Importantly, avoidable factors contributed to all of the patients with underlying diseases. These patients are particularly at risk and should take adequate precautions during summer months.

Adolescent↗
PubMed1997

Reconstruction for sequelae of septic hip in children.

Sequelae of septic hip in children may develop either due to inadequate management or neglect in the acute stage. We treated 13 patients (13 hips) with late sequelae of septic hip by reconstruction procedures, from 1985 to 1992. The mean age of the patients was 6.1 years. Their initial bony deformities were all beyond Hunka's classification type IIB. All of them had problems of hip instability and leg length discrepancy. With the intention to reestablish containment of the hip joint, open reduction, femoral osteotomy and pelvic osteotomy were performed. Four patients, all beyond Hunka type IV, had secondary surgery for hip resubluxation. Leg length discrepancies were corrected by valgus osteotomy and limb lengthening. At an average follow-up of 6.3 years, all remodeled hips were stable. Early reconstruction is recommended to stabilize the hip joint and restore the normal hip center for bone development. The leg length discrepancies were corrected by an Ilizarov limb lengthening procedure at a later stage.

Arthritis, Infectious↗
PubMed1997

[Survival and pulmonary hemodynamics in patients with sequelae of pulmonary tuberculosis who received home oxygen therapy].

We studied the relationship between survival and pulmonary hemodynamics in patients with sequelae of pulmonary tuberculosis. We also studied the effect of home oxygen therapy (HOT) on pulmonary hemodynamics in those patients. The subjects were 59 patients who were treated with HOT after right-heart catheterization. Blood gases and pulmonary hemodynamics were measured twice: while the patients breathed air and after they had inhaled pure oxygen. In 11 patients, right-heart catheterization done before and after HOT was begun. Before HOT was begun, 49 patients were given the diagnosis of pulmonary hypertension, but the difference in survival between those who had and those who did not have pulmonary hypertension was not statistically significant. Mean pulmonary artery pressure fell by more than 5 mmHg after inhalation of pure oxygen in 5 patients (responders), but survival did not differ between responders and non-responders. Blood-gas volumes and pulmonary hemodynamics did not differ between those who died within 2 years after right-heart catheterization and those who lived for more than 5 years. Pulmonary arterial resistance and mean pulmonary artery pressure decreased significantly after HOT was begun. HOT can reduce mean pulmonary artery pressure in patients with sequelae of pulmonary tuberculosis, but survival on HOT is not related to the presence of pulmonary hypertension or to the effect of pure oxygen on mean pulmonary artery pressure.

Blood Gas Analysis↗
PubMed1976

Remaining sequelae with modern perinatal care.

The incidence of major sequelae-cerebral palsy (CP), psychomotor retardation (PMR), sensorineural hearing defect, and acquired hydrocephalus--has been studied retrospectively in a nonselected population of 6,5000 3-year-old children born in 1969 and 1970 at one Swedish hospital and treated uniformly according to the principles of modern perinatology. The total incidence of these four types of handicaps was 3.5 per 1,000 when children with congenital malformation syndromes, chromosomal aberrations, verified congenital viral infections, or toxoplasmosis were excluded. The incidence of CP was 1.2 per 1,000. Extreme immaturity, traumatic delivery, postnatal asphyxia, and hyperbilirubinemia were found to be relatively small factors as causes of sequelae in this population. Babies showing various degrees of intrauterine malnutrition were found to be the major remaining group at risk for PMR and/or CP, two thirds of children with these handicaps being recruited from the 16% of newborns with birthweights more than 1 SD below normal in relation to gestational age. The most important further gains can probably be made by earlier intrauterine diagnosis of these cases, induced termination of pregnancy in selected cases, and further studies on the perinatal treatment and adaptation of these infants.

Birth Weight↗
PubMed1998

Dentoalveolar surgical sequelae.

Most general dental practitioners perform dentoalveolar surgery as part of their practice. Postoperative sequelae can cause great concern for patients and undue stress for the general practitioner. This article explains the importance of patient education with regard to these sequelae and discusses standard treatment modalities the practitioner can employ if they should arise.

Analgesics, Opioid↗
PubMed1998

Otitis media: pathogenesis and medical sequelae.

Eustachian tube abnormalities are a primary determinant of otitis media. Other determinants include viral infections and local and systemic immune deficiencies, which predispose to superimposed bacterial disease. Local infection induces inflammation, which can be exacerbated by the presence of antibiotics. The degree of inflammation determines the extent of damage and the oedema and histological damage correlate with the white blood cell count and not the bacterial count. Local sequelae include recurrent or persistent acute otitis media, recurrent or chronic otitis media with effusion and chronic suppurative otitis media. Other local sequelae include occasional perforation of the tympanic membrane, sensorineural hearing loss, acute serous labyrinthitis, and facial palsy, which can occur associated with the course of the facial nerve across the middle ear. Acute otitis media can lead to persistent loss of a significant amount of sensorineural hearing after treatment and resolution of the effusion. Damage is usually very mild or nonexistent in the speech frequency ranges, but detectable if high frequency audiometry is performed. Studies in otitis media with effusion have shown a mild association between its presence and speech and language development in children under the age of 4 years. But also in older children, there is a continued association between otitis media with effusion, affecting expressive language development, reading skills and behavior. Therefore physicians have a major responsibility in managing otitis media.

Acute Disease↗
PubMed1997

[Cognitive sequelae following rupture of aneurysms of the anterior communicating artery and the anterior cerebral artery. Retrospective study of 56 cases].

The neuropsychological records of 56 patients operated for clipping were studied. Almost every patient remained autonomous and without invalidating motor defect. The present study was aimed at specifying the type and frequency of neuropsychological sequelae and, to a lesser extent, the role of various pathophysiological factors. A main concern was to examine to what extent and at what post-operative interval the neuropsychological assessment can predict the intellectual and socioprofessional outcome of each individual patient. The neuropsychological assessment performed beyond the acute phase showed evidence of intellectual sequelae in about two thirds of the patients. Only one case of permanent anterograde amnesia was observed, probably due to unavoidable inclusion of a hypothalamic artery in the clip during surgery. Transient anterograde amnesia and confabulations were occasionally observed, generally for less than three weeks. A common finding was impaired performance on memory and/or executive tests. In a minority of patients, language disorders, visuoperceptive and visuoconstructive disabilities were found, probably in relation with hemodynamic changes at distance from the aneurysm. Global impairment of intellectual function was not uncommon in the acute post-operative phase but it evolved in most cases towards a more selective impairment, for instance restricted to executive and memory functions, in the chronic phase. The neuropsychological investigation carried out 4 to 15 weeks post-operatively provided satisfactory information about possible long-lasting intellectual disturbances and professional resumption. In particular, persistent global intellectual impairment, persistent amnesia and confabulations 4-15 weeks post-operative were associated with cessation of professional activity; executive and memory impairment, behavioral disturbances such as those encountered in patients with frontal lobe damage were associated with a decreased probability of full-time employment. Pre- and post-operative angiography were not good predictors of long-term cognitive outcome: normal angiography was not necessarily followed by normal neuropsychological outcome, conversely abnormal angiography could be found together with normal neuropsychological outcome. By contrast, there was a relationship between left-lateralised abnormalities on post-operative angiography and occurrence of language disorders; similarly, there was a relationship between side of craniotomy and type of deficits, that is language disorders versus visuoperceptive-visuoconstructive impairments.

Adult↗
PubMed1997

[Complications and abdominal wall sequelae in pedicle TRAM breast reconstruction].

The doubts concerning silicon implants since 1991 have led to the development of autologous tissue reconstruction and especially pedicle rectus abdominis flap (TRAM). The good cosmetic results obtained on the reconstructed breast also promoted the development of this technique. However, the complications and donor site sequelae must not be underestimated. The abdominal wall is considerably modified in terms of muscle strength and residual scars. It can be the site of complications such as herniae and scar necrosis. In order to more accurately assess these risks, the authors studied a series of 251 TRAM breast reconstructions performed at the Institut Gustave-Roussy between 1982 and 1992. The rate of herniae requiring reoperating decreased considerably with improvement of the technique, falling from 10% to less than 2% in the most recent cases, with a mean rate of 7% for the overall series. Infraumbilical scar necrosis was not exceptional, but the incidence appeared to decline with the surgeon's experience (about 5%). This depended on the patient's clinical context, especially a history of smoking. The strength of contraction of the upper segment of the muscle was significantly decreased and the cosmetic results of the abdominal scar were not always favourable as they were considered to be satisfactory in only 70% of cases. This study demonstrates the importance of not underestimating the sequelae of donor site scars, which must be taken into account when evaluating the results of the technique.

Abdominal Muscles↗
PubMed1998

Therapy and prophylaxis of acute and late radiation-induced sequelae of the esophagus.

BACKGROUND: Radiation-induced esophagitis is a frequent acute side effect in curative and palliative radiotherapy of thoracal and cervical tumors. Late reactions are rare but might be severe. METHODS: A research for reports on prophylactic and supportive therapies of radiation-induced esophagitis was performed (Medline, Cancerlit, and others). RESULTS: Nutrition must be ensured and symptomatic relief of sequelae is important, especially in the case of dysphagia. The latter can be improved by topic or systemic analgetics. If esophageal spasm occurs, calcium antagonists might help. In case of gastro-esophageal reflux proton pump inhibitors should be used. There is no effective prophylactic measure for radiation esophagitis. Late side effects with clinical relevance are rare in conventional radiotherapy. Chronic ulcera, fistula or stenosis may develop. Before any treatment, a tumor infiltration of the esophagus should be excluded by biopsy. This can lead more often to late complications than radiation therapy itself. Nutrition should be ensured by endoscopic dilation, stent-implantation, or endoscopic percutaneous gastrostomy. Local injection of steroids might be used to avoid an early restenosis. CONCLUSIONS: An intensive symptomatic therapy of acute esophagitis is reasonable. Effective prophylaxis do not exist. Late radiation induced sequelae is rare. Therefore, a tumor recurrence should be excluded in cases of dysphagia. Securing nutrition by PEG, stent, or port is well in the fore.

Amifostine↗
PubMed1998

[Survival and pulmonary hemodynamics in patients with sequelae of pulmonary tuberculosis who received antituberculosis chemotherapy and home oxygen therapy].

To date, the pulmonary hemodynamics of patients with sequelae of pulmonary tuberculosis have usually been examined as a unified set of criteria regardless of the treatments that patients undergo. Attracted by this subject, we studied the cerrelations between survival and pulmonary hemodynamics in patients with sequelae of pulmonary tuberculosis who were treated with antituberculosis drugs and home oxygen therapy (HOT). Our study examined 21 patients with a mean ages of 58.0 years, mean PaO2 of 59.3 +/- 11.4 mm Hg, and mean PaCO2 of 51.9 +/- 6.3 mm Hg. In pulmonary function tests, mean % VC was 44.1 +/- 16.3%, and mean FEV 1%, 66.6 +/- 23.0%. Twenty of the patients were given a diagnosis of pulmonary hypertension. Eighteen of the patients received HOT; as a group, their 3-year survival rate was 62.6%, which was not statistically significant compared to survival observed in post Japanese studies. Among the HOT patients, blood gases and pulmonary hemodynamics did not vary significantly between those who died within 2 years after right heart catheterization (short-term survivors) and those who lived for more than 5 years (long-term survivors). However, VC, % VC, and FVC values were significantly lower in the short-term survivors than in the long-term survivors. In conclusion, these findings revealed no statistically significant, differences compared with the data from past studies. Although pulmonary hypertension is associated with the poor prognosis for chronic obstructive pulmonary tuberculosis patients, in the patients we studied, the principle prognostic determinant was the seriousness of the restrictive ventilatory impairment, not pulmonary hypertension.

Aged↗
PubMed1990

Hepatitis B-related sequelae. Prospective study in 1400 hepatitis B surface antigen-positive Alaska native carriers.

A total 1400 hepatitis B surface antigen-positive Alaska natives, 824 men and 576 women of all ages, were followed up prospectively over a period of 7815 carrier years for the development of sequelae related to chronic hepatitis B virus infection. During the observation period, 20 cases of hepatocellular carcinoma, 14 cases of chronic active hepatitis, 8 cases of cirrhosis, and 1 case of glomerulonephritis developed in this cohort. The annual incidence of hepatocellular carcinoma was 387 per 100,000 for men and 63 per 100,000 for women. The incidence of chronic active hepatitis and cirrhosis was 193 and 107 per 100,000 in men and 158 and 95 per 100,000 in women, respectively. No cases of either essential mixed cryoglobulinemia or necrotizing vasculitis were seen. Sixty of the hepatitis B surface antigen-positive carriers died, with 13 (21.7%) of the deaths due to hepatocellular carcinoma. The leading cause of death in this group was malignant neoplasms compared with accidents in the general Alaska native population.

Adolescent↗
PubMedDate not supplied

Alveolar echinococcosis of the liver: sequelae of chronic inferior vena cava obstructions in the hepatic segment.

BACKGROUND: The clinical pattern and long-term course of chronic inferior vena cava (IVC) obstructions are variable and depend on the underlying cause, the segment involved, and the extension of secondary thrombosis. Pertinent data on IVC obstructions in well-defined series of patients are lacking. We report the sequelae of chronic IVC obstructions in the hepatic segment in 11 consecutive patients derived from a cohort of 104 patients with alveolar echinococcosis of the liver. METHODS: Based on the results of computed tomography scans, 11 patients (7 men, 4 women; mean age, 53.4 years) with IVC obstructions were selected from an ongoing prospective long-term chemotherapy trial comprising 104 patients with alveolar echinococcosis studied at yearly intervals according to a protocol. Obstruction of the IVC in the 11 patients existed for a mean duration of 8.6 years. In these patients, magnetic resonance imaging was performed to assess the morphologic features and extension of the IVC obstruction, as well as the collateral venous pathways. Patency and valvular function of the femoropopliteal veins were analyzed by color-coded duplex ultrasonography. RESULTS: Total occlusions of the IVC were evident in 8 patients (73%) and subtotal stenoses in 3 patients (27%). Only 4 patients (36%) exhibited signs and symptoms of chronic venous insufficiency of the lower extremities; 2 (18%) of the 4 had a history of swelling in the lower extremity. Seven patients (64%) had no lower extremity symptoms. One patient had a history of pulmonary embolism. Abdominal collateral veins were documented in 5 patients (45%) by using magnetic resonance imaging; however, they were clinically evident in only 3 patients (27%). In the 8 patients with IVC occlusion, thrombosis ended at the confluence of the hepatic veins. Obstruction of the IVC was limited to the hepatic segment in 2 patients (18%) and extended to the distal IVC or the iliofemoral veins in 6 patients (54%). Chronic venous insufficiency was present only if the femoropopliteal veins had been involved in the thrombotic process, showing residual venous obstruction, valvular incompetence, or both. Bilateral renal vein thrombosis with moderate proteinuria was observed in 2 patients (18%). The main collateral drainage was achieved through the ascending lumbar, azygos, and hemiazygos veins. CONCLUSIONS: In patients with alveolar echinococcosis, obstruction of the IVC in the hepatic segment often develops asymptomatically and rarely leads to the impairment of renal function. The collateral circulation fully compensates for obstruction of the IVC. Thrombotic involvement and valvular incompetence of the femoropopliteal veins seems to determine the development of chronic venous insufficiency of the lower extremities.

Adult↗
PubMed1975

Neurological sequelae of malignant external otitis.

The neurological sequelae of malignant external otitis (MEO) form a characteristic syndrome. Following Pseudomonas external otitis, usually in an elderly, diabetic patient, either isolated facial nerve paralysis or multiple cranial nerve palsies develop. Once extensive neurological signs have developed, recovery rarely occurs. We saw a patient with MEO and multiple cranial nerve palsies who recovered following an extended course of gentamicin sulfate and carbenicillin disodium therapy.

Abducens Nerve↗
PubMed1978

Behavioral sequelae of closed head injury. A quantitative study.

We determined the profile of behavioral disturbance in relation to closed head injury of graded severity. Patients with severe injuries, as defined by duration of coma and the presence of neurological deficit, were differentiated from a group of mildly injured patients by behavioral ratings that reflected cognitive disorganization, emotional withdrawal, and motor retardation. Neurologic measurements of injury related to the severity of behavioral disturbance included hemiparesis, aphasia, and abnormalities on computerized axial tomography. Agitation during the acute phase of injury was also predictive of residual behavioral disturbance. Hemispheric lateralization of the site of greatest injury had no discernible effect on behavioral sequelae.

Adult↗
PubMed1997

Cognitive sequelae of unilateral posteroventral pallidotomy.

OBJECTIVE: To examine the cognitive sequelae of unilateral posteroventral pallidotomy. DESIGN: Single-group pretest and posttest methodologic assessment with baseline evaluation performed 1 to 2 days prior to surgery and follow-up conducted 3 months after pallidotomy. SETTING: Movement disorder clinic at a university medical center. PATIENTS: Fourteen patients (age range, 43-82 years) with Parkinson disease (average disease duration, 7.4 years). INTERVENTION: Unilateral posteroventral pallidotomy procedures were performed on the right (n=8) and left (n=6) side of the brain. MAIN OUTCOME MEASURES: The protocol consisted of a range of neuropsychological instruments sensitive to subcortical dysfunction, including measures of bi-manual coordination, simple-complex reaction time, visual attention, naming, verbal fluency, learning, recognition memory, and problem solving. RESULTS: No significant deterioration in specific cognitive abilities was observed as a function of the procedure. Patients showed a significant improvement in motor coordination speed for both contralateral and ipsilateral upper extremities. CONCLUSIONS: Stereotactic unilateral posteroventral pallidotomy is associated with minimal risk of adverse neuropsychological effects or cognitive decline. Additional research is warranted, with an increased sample size and extended follow-up, to assess any potential lateralized effects of the procedure.

Adult↗
PubMed1978

Developmental and psychoeducational sequelae of chronic otitis media.

The developmental, psychological, and educational sequelae of chronic otitis media occurring during the first three years of life were investigated in a selected group of children with educational difficulties. One group of children had a history of chronic and severe otitis media, requiring myringotomy after 3 years of age. The control group had infrequent and relatively mild episodes of otitis media and no surgical intervention. Children with chronic and severe otitis media manifested substantial delays in speech and language, auditory processing deficits, disturbances in auditory-visual integration, reading disorders, and poor spelling skills. Early medical and educational intervention for children with a high-risk profile of language delay and severe chronic otitis media is suggested as a possible strategy for preventing the development of a specific learning disability.

Auditory Perception↗
PubMed1984

Cranial radiation in childhood acute lymphocytic leukemia. Neuropsychologic sequelae.

A battery of neuropsychologic tests was administered "blindly" to 18 children with acute lymphocytic leukemia (ALL) who had been randomly assigned to treatment regimens with or without cranial radiation. These children were all in complete continuous remission for more than 3 1/2 years and were no longer receiving therapy. The results indicated no substantial differences between groups as a function of radiation therapy. However, decreased neuropsychologic performance was found when the entire sample was compared with population norms. These data do not support the hypothesis that cranial radiation therapy is responsible for the neuropsychologic sequelae seen in these survivors of ALL. Post hoc multiple regression analysis indicated that parental education levels accounted for more of the neuropsychologic variability seen in these children than other factors such as age at diagnosis, type of therapy, or sex of child.

Brain↗