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PubMed1985

Neurologic sequelae of cardiac catheterization.

Neurologic complications are a known and at times tragic consequence of cardiac catheterization. During a four-year period, 1,362 procedures were performed at our institution on children less than 15 years of age. Eighteen children, without prior nervous system disease, developed neurologic sequelae within 24 hours of cardiac catheterization (1.3%). Three presented with seizures only, ten with neurologic deficits, and five with both focal seizures and stroke. Computerized tomography scans (16 patients) demonstrated areas of nonhemorrhagic infarction in all but one. The 18 patients were studied retrospectively for possible factors contributing to the neurologic complications. They were matched to controls by age, cardiac lesion, and catheterization technique. Data examined included catheterization duration and approach, contrast agent, precatheterization urine specific gravity, pre- and postcatheterization hematocrit, blood loss, and intracatheterization events. Catheter and catheter sheath clots were noted in both patient groups. The neurologic complication group had 7/18 intracatheterization neurologic events versus only one in the controls and the change in hematocrit was greater in the complication group (t = 2.89, p less than 0.01). Due to this study's results and to prevent possible thromboembolic events, a heparinization protocol was instituted and patients were prospectively observed for neurologic complications. No neurologic complications have occurred over three years since the institution of this protocol.

Cardiac Catheterization↗
PubMed2002

Sequelae of axillary lymph node dissection in older women with stage 1 and 2 breast carcinoma.

BACKGROUND: There are few data on the long-term sequelae of axillary dissection among older breast carcinoma patients. We describe the impact of axillary dissection in a cohort of older women. METHODS: A longitudinal cohort of 571 patients with Stage 1 and 2 breast carcinoma, 67 years and older, diagnosed between 1995 and 1997 from 29 hospitals in five regions, and followed for 2 years. Data were collected from patients and medical charts. The primary outcome was posttreatment quality of life. Generalized estimation equation longitudinal modeling was used to evaluate the outcome, controlling for baseline function, comorbidity, age, clinical status, and other factors. RESULTS: Sixty percent of women reported arm problems at some time in the 2 years after surgery. The cumulative risk of having arm problems 2 years posttreatment was three times higher (95% confidence interval 1.94-4.67) for women who underwent axillary surgery compared with women without axillary surgery, controlling for covariates. The effects of having axillary dissection and arthritis were multiplicative 2 years postsurgery. Arm problems were, in turn, the primary determinate of lower physical and mental functioning (P = 0.0001 and 0.04, respectively), controlling for other factors. Undergoing axillary dissection did not lessen fears about recurrence. CONCLUSIONS: Arm problems after axillary dissection have a consistent negative impact on quality of life, suggesting that the risks may outweigh the potential benefits in this population.

Aged↗
PubMed2005

Chronology of behavioral symptoms and neuropathological sequela in R6/2 Huntington's disease transgenic mice.

Genetic murine models play an important role in the study of human neurological disorders by providing accurate and experimentally accessible systems to study pathogenesis and to test potential therapeutic treatments. One of the most widely employed models of Huntington's disease (HD) is the R6/2 transgenic mouse. To characterize this model further, we have performed behavioral and neuropathological analyses that provide a foundation for the use of R6/2 mice in preclinical therapeutic trials. Behavioral analyses of the R6/2 mouse reveal age-related impairments in dystonic movements, motor performance, grip strength, and body weight that progressively worsen until death. Significant neuropathological sequela, identified as increasing marked reductions in brain weight, are present from 30 days, whereas decreased brain volume is present from 60 days and decreased neostriatal volume and striatal neuron area, with a concomitant reduction in striatal neuron number, are present at 90 days of age. Huntingtin-positive aggregates are present at postnatal day 1 and increase in number and size with age. Our findings suggest that the R6/2 HD model exhibits a progressive HD-like behavioral and neuropathological phenotype that more closely corresponds to human HD than previously believed, providing further assurance that the R6/2 mouse is an appropriate model for testing potential therapies for HD.

Animals↗
PubMed1986

Physical and behavioral sequelae of low birthweight in spiny mice (Acomys cahirinus).

Physical and behavioral sequelae of low birthweight (LBW) were investigated in spiny mice (Acomys cahirinus). When raised by their biological mother, pups whose Day-2 weights were 1 SD or more below the population mean remained smaller through the first 30 days postpartum than pups born within normal (N) weight ranges. LBW pups fostered onto mothers who gave birth to N pups gained weight more rapidly than LBW pups remaining with their own mother. Similarly, N pups fostered onto mothers of LBW pups displayed reduced weight gain relative to N siblings raised by their biological mother. It appears that rate of weight gain is influenced by an interaction between birthweight and maternal rearing environment. LBW pups also were less responsive than N pups to maternal chemical cues, indicating that low birthweight is correlated with deficits in adaptive behavior.

Animals↗
PubMed1977

Psychological sequelae of sterilization in women in Singapore.

The Chinese in Singapore erroneously believe that there is an association between sterilization and castration. This belief has led to deep-seated fears that sterilization may result in obesity, physical weakness, and impairment of sexual function. Beginning in 1969, Singapore authorities introduced increasingly stronger social policies to help reduce family size. Subsequently, there was a large increase in the number of tubal ligations. It was initially thought that this might result in a high incidence of psychological sequelae. A study of 150 women who had had culdoscopic ligations showed that 6.3 percent were dissatisfied at the end of 2 years. Women with fewer than 4 children and those with fewer than 2 sons tended to be more dissatisfied with sterilization.

Adult↗
PubMed1978

Hearing loss as a sequela of meningitis.

A retrospective study of 547 cases of meningitis was performed. Of these, 236 were bacterial, 304 were viral, and 7 were fungal in etiology. Of 110 survivors of bacterial meningitis over the age of 2 1/2 years, 23 or 21% suffered partial or complete sensorineural hearing loss. The site of auditory injury in cases of partial loss was the cochlea by audiologic criteria. A positive correlation with hearing loss was found for the species of organism, delay before treatment, low CSF sugar, and CSF pleocytosis. Of 7 patients with fungal meningitis, 3 suffered hearing loss with signs of a retrocochlear site. Of 304 cases of aseptic meningitis, none developed a hearing loss. The pathophysiology of hearing loss as a sequela of meningitis and the possible explanations for absence of hearing loss in viral meningitis are discussed.

Adolescent↗
PubMed1992

Movement disorders as sequelae of central pontine myelinolysis: report of three cases.

In three survivors of central pontine myelinolysis, dystonia (in two patients) and rest tremor (in one) were sequelae. The onset of these movements occurred 3 weeks to 5 months after the initial presentation with central pontine myelinolysis. Magnetic resonance imaging revealed basal ganglia lesions suggestive of extra-pontine myelinolysis in all three patients. We propose that the movement disorders seen in our cases are clinical correlates of extra-pontine myelinolysis.

Demyelinating Diseases↗
PubMed1979

Central nervous system alterations as sequelae of Venezuelan equine encephalitis virus infection in the rat.

Alterations of the Central Nervous System (CNS) in rats surviving acute infection with a virulent strain of Venezuelan Equine Encephalitis (VEE) virus were studied by light and electron microscopy. Cavitary necrosis of the cerebral cortex, macrophage activity and degenerative axonal changes were considered to be sequelae of the lesions induced during the acute phase of the infection. Mononuclear cell infiltrates of the neuropil, 3 mth after inoculation, were related to the immune response of the host. Focal lesions and mononuclear cell activity in the brain are thought to be the equivalent of the lesions induced in the CNS of humans during VEE virus infection. The findings are discussed in the light of recent reports of cerebral dysfunction occurring as a sequel of VEE virus infection in children.

Animals↗
PubMed1992

The psychosocial sequelae of a second-trimester termination of pregnancy for fetal abnormality.

A retrospective study to investigate the psychosocial sequelae of a second-trimester termination of pregnancy (TOP) for fetal abnormality (FA) is described. After appropriate consent was obtained, 84 women and 68 spouses were visited 2 years after the event and asked to complete an extensive questionnaire. Most couples reported a state of emotional turmoil after the TOP. There were differences in the way couples coped with this confusion of feelings. After 2 years about 20 per cent of the women still complained of regular bouts of crying, sadness, and irritability. Husbands reported increased listlessness, loss of concentration, and irritability for up to 12 months after the TOP. In the same period, there was increased marital disharmony in which 12 per cent of the couples separated for a while and one couple obtained a divorce. These problems could be attributed to a lack of synchrony in the grieving process. Confusing and conflicting feelings led to social isolation and lack of communication. Difficulties in coming to terms with the fetal loss were not found to be linked to the type of fetal abnormality or religious beliefs but were related to parental immaturity, inability to communicate needs, a deep-rooted lack of self-esteem before the pregnancy, lack of supporting relationships, and secondary infertility. Suggestions for improved management are given.

Abortion, Therapeutic↗
PubMed2003

Chorioangioma and its severe infantile sequelae: case report.

OBJECTIVE: This case report describes a rare clinical presentation of chorioangioma diagnosed prenatally because of raised-maternal serum (MS) alpha-fetoprotein. METHODS: A thirty-year-old woman gravida 2, para 1 was referred to the ultrasound unit at 18 weeks of gestation because of abnormal MS triple-test results. This included AFP level of 14.9 MoM; hCG of 3.42 MoM and uE3 of 1.01 MoM. A detailed anomaly scan revealed a singleton fetus with no sonographically detectable malformations and normal amniotic fluid. The placenta was posterior. A well-circumscribed, rounded, predominantly hypoechoic lesion near the chorionic surface measuring 5 x 5 cm and protruding into the amniotic cavity was detected. Color Doppler sonogram showed no blood flow within the mass, but clear fetal waveforms in its periphery were demonstrated, and the diagnosis of chorioangioma was made. The pregnancy was followed uneventfully until 35 weeks of gestation when polyhydramnios and severe fetal cardiomegaly developed. Labor was therefore induced. RESULTS: A euploid female, who had multiple diffuse cutaneous and liver angiomatosis was born. She died at the age of one month because of cardiac failure and infection. CONCLUSIONS: The present case alerts to the interrelationship between placental and fetal angiomas. This may lead to severe infantile sequelae because of similar lesions.

Adult↗
PubMed1988

Absence of long term pulmonary sequelae after mild meconium aspiration syndrome.

To assess residual damage from meconium aspiration syndrome (MAS), we studied 12 children, ages 6 to 9 years, an average of 7.4 years after injury. Our sample consisted of mildly affected patients, only one having required intubation and mechanical ventilation in the acute phase of illness. In each child we measured FVC, FEV1, PEFR, MMEFR, VisoV, lung volumes by plethysmography, DLCO and calculated FEV1/FVC and RV/TLC. Methacholine bronchial challenge was performed and the PD20 was calculated. These results were compared with those obtained from a group of 12 normal children studied in our laboratory. No significant difference was found for pulmonary function parameters studied, except for VisoV which was greater in MAS patients than normals (P less than 0.02). Given the inherent high degree of variability with VisoV, we were not able to ascribe this isolated finding to be indicative of small airway disease in these asymptomatic patients. We conclude that patients with mild to moderate initial insult from MAS show an absence of pulmonary sequelae when tested at an average of 7.4 years of age.

Bronchial Provocation Tests↗
PubMed2004

Three-dimensional ultrasound diagnosis of Larsen syndrome with further characterization of neurological sequelae.

Larsen syndrome consists of skeletal dysplasia with multiple joint dislocations and a characteristic facies. The basis of this abnormality is a generalized mesenchymal disorder involving connective tissues. We describe our findings in a woman who was referred at 28 weeks' gestation due to multiple fetal anomalies suspected initially at an 18-week ultrasound examination. On three-dimensional (3D) ultrasound we found the fetus had bilateral genu recurvatum. Further 3D examination at 36 weeks confirmed the lower limb anomaly and revealed facial anomalies that led to the diagnosis of Larsen syndrome. An elective Cesarean section was performed at 38 weeks' gestation to minimize neurological sequelae. Magnetic resonance imaging was performed postnatally and showed pachygyria, colpocephaly and agenesis of the corpus callosum. In this case, 3D ultrasound facilitated the prenatal diagnosis of Larsen syndrome. A careful prenatal investigation for other associated anomalies such as those of the cardiovascular or neurological systems is warranted with this diagnosis. These associated lesions are likely to have a greater impact on prognosis than the classic symptoms of Larsen syndrome and a collaborative approach is necessary to optimize delivery and postnatal management of an affected fetus.

Adult↗
PubMed1993

Neuropsychological sequelae of Wernicke's encephalopathy in a 20-year-old woman: selective impairment of a frontal memory system.

This article reports the neuropsychological sequelae of Wernicke's Encephalopathy in a 20-year-old woman. After amelioration of acute symptoms, the patient showed a range of cognitive impairments the most marked of which was a severe impairment on free recall tasks involving both verbal and nonverbal material. In contrast, recognition memory appeared remarkably well preserved. Some evidence of frontal lobe and general intellectual impairment was also noted. The case is discussed in terms of the pathophysiology of Wernicke-Korsakoff Syndrome, criteria for its diagnosis, and the multicomponent nature of memory deficits.

Adult↗
PubMed2000

Neurofilament-rich intraneuronal inclusions exacerbate neurodegenerative sequelae of brain trauma in NFH/LacZ transgenic mice.

Several neurodegenerative disorders are characterized by filamentous inclusions in neurons that selectively degenerate. The role these inclusions play in neuron degeneration is unclear, but this issue can be investigated experimentally in relevant animal models. The NFH/LacZ transgenic (TG) mice overexpress the high-molecular-weight neurofilament (NF) subunit (NFH) fused to beta-galactosidase, and these hybrid proteins aggregate into NF-rich, filamentous neuronal cytoplasmic inclusions (NCIs) that have been implicated in the progressive, age-dependent degeneration in subsets of affected neurons. Thus, these TG mice recapitulate some of the key pathology of neurodegenerative disorders with intraneuronal inclusions. To determine if the NCIs compromise neuron survival following traumatic brain injury (TBI), 3- to 6-month old TG and wild-type (WT) mice were subjected to TBI or sham injury. At 2 weeks post-TBI, the TG group showed increased TUNEL staining and activated caspase-3 immunoreactivity in cells of cerebral cortex, adjacent white matter, and hippocampus underlying the injury site, relative to control mice, but this labeling decreased at 4 weeks and was minimal thereafter. Compared to control mice, by 8 weeks postinjury, the TG mice showed a marked decrease in neuron density and increased gliosis in the hippocampal dentate gyrus and CA3 region as well as in the lateral thalamus, while the few remaining CA3 neurons exhibited cytoskeletal alterations, decreased synaptic protein immunoreactivity, and dissolution of NCIs. The more profound long-term neurodegenerative sequelae of TBI in the NFH/LacZ mice compared to WT mice suggest that the presence of intraneuronal inclusions may impair the recovery and long-term viability of injured neurons.

Animals↗
PubMed1980

Long-term sequelae of cancer chemotherapy.

Long-term sequelae of therapy of neoplastic disease have become an important topic, since many patients exposed to anticancer drugs will have prolonged survival. The advances which have been made in the treatment of pediatric malignancies, in fact, give particular relevance to a study of these complications. Moreover, clues as to the mechanism of action and molecular pharmacology of these agents may emerge from such studies. Herein we review both the specific organ dysfunction and the generalized effects which may become apparent as late consequences of chemotherapy.

Antineoplastic Agents↗
PubMed1983

Neuroradiology of the sequelae of spinal cord trauma.

More than 850 patients with acute injuries to the spinal cord were explored by means of neuroradiological procedures (1954-1981). The sequelae of cord damage were assessed in 125 of these patients and the results of neuroradiological examinations correlated with the surgical or autopsy findings. Such opportunities to demonstrate the changes that follow the acute phase of a spinal cord injury are infrequent because of a lack of centralized team care and continuity of follow-up. Chronic post-traumatic changes, induced by mechanical kinetic or non-mechanical energies, were demonstrated after a long period of time, occasionally after two to ten years. They were classified into six groups. Disturbances of arterial circulation are emphasized as a major source of aggravation of the post-traumatic state of the spinal cord.

Abscess↗
PubMed1990

[Subjective sequelae of splenectomy].

111 of 806 former patients splenectomized at the Würzburg university hospital during the years 1968-1983 were interviewed for their complaints since their operation. Investigations included the use of Beck's inventory for measuring depression and the Giessen questionnaire for the evaluation of general complaints used in psychosomatic medicine. There was a significant increase of symptoms after splenectomy as compared to the normal population. A special list of 18 questions to investigate typical postsplenectomy complaints was answered by 95 of these 111 persons and by a control group of "statistical twins" with similar upper abdominal surgery without splenectomy. The leading difference was the highly significant increase of the susceptibility to infections after splenic loss followed by accelerated exhaustion and increased physical and mental weakness. The distribution of other complaints like for instance the intolerance to alcohol hitherto judged as typical sequelae of splenectomy was not statistically different in both splenectomy was not statistically different in both groups. Since the symptoms listed above as significantly increased in the splenectomized patient were closely correlated with the susceptibility to infection they seem to be rather the expression of the decreased resistance than direct consequences of the loss of the spleen.

Adolescent↗
PubMed1995

[Compartment syndrome. Frequently missed, with severe sequelae].

Experience and late results in patients with a compartment syndrome which was either missed or diagnosed too late are reported. In the case of 14 patients we were consulted after a delay of 24 h, in another three patients 48 h after the causative event. At that time the diseased extremity was severely swollen, blistered and extremely painful. Ten patients presented with loss of sensitivity; in eight the peripheral pulses were not palpable. CPK was elevated in nine patients (up to 30,000); in six patients CPK was not determined. Causative factors included vascular occlusion (n = 6), paravenous infusions or injections (n = 4), compression in heroin or alcohol abusers (n = 4) and infections secondary to i.m. injections, sepsis or snake bites (n = 4). One patient developed a compartment syndrome after the closure of a muscular hernia. The late results were sobering: eight limbs had to be amputated, another 13 showed muscle necrosis necessitating necrosectomy, and both transitory and persistent median, ulnar, radial and peroneal nerve damage was observed. Our experience shows that dermatofasciotomy should be done on a more generous scale, because it obviously prevents sequelae and because the late complications following inadequately treated compartment syndromes are grave.

Adolescent↗