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PubMed1994

The sequelae of vertebral crush fractures in men.

The number of osteoporotic fractures is rising in men and women, because of the demographic trend towards an aging population and an increase in the age-specific incidence of fractures. Although previous studies have examined the morbidity following hip fractures in women, there is little information on the sequelae of vertebral crush fractures in men. We have therefore collected data on loss of height, kyphosis, peripheral fractures and functional status in 63 men with symptomatic vertebral fractures. Loss of height was documented in 49% of the men, while kyphosis was present in 54%. A past history of 50 non-vertebral fractures was obtained in 27 patients (43%), involving the ribs (17), lower arm (13) and femoral neck (4). Each patient then completed the Nottingham Health Profile (NHP), which gives information on perceived health. Men with vertebral crush fractures had higher scores for all six domains of the NHP when compared with age-matched and more elderly control subjects, implying greater morbidity. This was particularly marked for the energy, pain and mobility domains of the NHP. We conclude that there is considerable morbidity associated with vertebral crush fractures in men, which should be assessed in any trial of therapeutic intervention. This study suggests that the NHP may be a useful instrument in this regard.

Adult↗
PubMed1995

Enterococcus faecalis colonisation and endocarditis in five intensive care patients as late sequelae of selective decontamination.

OBJECTIVE: To describe Enterococcus faecalis colonisation and endocarditis in 5 intensive care patients after treatment with selective decontamination (SDD). SETTING: Intensive care unit (ICU) in a general hospital. PATIENTS: The patients were admitted to the ICU because of adult respiratory distress syndrome, polytrauma (2 patients), abdominal aortic surgery and gastrointestinal surgery. Because these patients needed mechanical ventilation they received systemic cefotaxime and SDD (polymyxin E, amphotericin B and norfloxacin). RESULTS: Colonisation with E. faecalis was documented in all patients. Intravascular catheter-related infection with E. faecalis occurred in 4 patients. None of the patients received antibiotics active against, E. faecalis, because body temperature normalised after catheter removal. In the course of his ICU stay one patient died. Autopsy showed E. faecalis endocarditis. The other 4 patients recovered from their primary illness, but had to be readmitted after several months because of E. faecalis endocarditis. One of these patients died. One patient recovered of endocarditis, but one year later valve surgery was necessary. The other 2 patients needed acute valve replacement. The latter 3 patients survived. CONCLUSION: We observed 5 patients with E. faecalis endocarditis as a late and severe sequela of SDD during their ICU stay.

Aged↗
PubMed1996

Accidental choke-cherry poisoning: early symptoms and neurological sequelae of an unusual case of cyanide intoxication.

We report the case of a 56-year-old woman who was accidentally poisoned when she ingested choke cherries whose pulp contained cyanide, and describe the acute clinical picture, the neurological sequelae and the neuroradiological findings. After recovery from coma, the patient showed signs of a parkinsonian syndrome, retrobulbar neuritis and sensory-motor neuropathy. MRI showed abnormal signal intensities involving the basal ganglia. Since no memory deficits were observed, we argue that the parkinsonian syndrome was caused by cyanide intoxication rather than by subcortical damage due to hypoxia.

Amygdalin↗
PubMed1990

Long term sequelae of frostbite.

Frostbite injury in the hands and feet of a child can have long-term sequelae, Premature fusion and abnormal growth can occur in the epiphyseal cartilage.

Bone Development↗
PubMed1989

Clinical sequelae and sacroiliac joint changes by computed tomography after recovery from septic sacroiliitis.

Nine cases of septic sacroiliitis were re-examined clinically and by CT after a follow-up period of 1.5-7 years. At the final check-up, six of the patients were asymptomatic, while pain could be provoked by palpation or compression in three cases. The sacroiliac joint CT findings were considered normal in two cases. Joint space narrowing, subchondral sclerosis, cysts, erosions, ankylosis and/or osteophytes were detected in seven cases. We conclude that recovery from septic sacroiliitis is good although destructive and degenerative changes often develop as sequelae of an osteolytic involvement.

Adult↗
PubMed1990

Interstitial cell infiltrate and myocardial fibrosis in dilated cardiomyopathy: a special type of cardiomegaly corresponding to sequelae of myocarditis.

We examined the relationship between interstitial cell infiltration and myocardial fibrosis in patients with clinically diagnosed dilated cardiomyopathy (DCM). Forty-two cases of DCM were divided into two groups, according to the mean number of the interstitial round cells per 10.2 x 10(4) square microns (Nic): the inflammatory group (Nic greater than or equal to 5) and noninflammatory group (Nic less than 5). The 12 cases in the inflammatory group were clinically similar to the 30 cases in the non-inflammatory group, but the inflammatory group exhibited a significantly (P less than 0.001) larger area of myocardial fibrosis (34.8% +/- 12.8% vs 17.5% +/- 8.2%), a significantly (P less than 0.01) higher frequency of diffuse perimyocytic-type fibrosis (83% vs 23%), fewer myocardial cells in the left ventricular wall (170 +/- 70 fibers vs 216 +/- 81 fibers), and significantly (P less than 0.01) greater hypertrophy of the myocytes (18.3 +/- 3.4 vs 15.3 +/- 2.7 microns). In addition, cases exhibiting marked fibrosis (fibrosis area greater than or equal to 25% of the myocardium) had a significantly higher Nic score (8.3 +/- 6.8) compared to cases with the less fibrotic type of DCM (4.0 +/- 5.7). We speculate that persistent or preceding inflammatory cell infiltration induces the myocardial fibrosis, especially the diffuse perimyocytic type, in the fibrosis-predominant type of DCM. Therefore, most of these cases may be a sequela of myocarditis, and more correctly termed post-myocarditic cardiomegaly.

Cardiomyopathy, Dilated↗
PubMed1994

Psychological, psychosocial, and psychophysiological sequelae in a community affected by a railroad chemical disaster.

Psychological, psychosocial, 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. Two hundred twenty exposed residents were compared to 114 controls and paired on age, education, gender, race, and number of children. A clinical interview and physiological measurements (blood pressure, pulse, and cortisol level) were taken, the MMPI-2, IES Scale, Mood Scale, Environmental Worry, Perceived Social Support, and Perceived Control Scale and a questionnaire were administered. Results indicated greater levels of depression, anxiety, and somatic symptoms in the spill residents in addition to greater environmental worry and lower perceived social support. Spill residents had higher blood pressure and less fluctuation of cortisol levels than controls. No difference on litigation status was obtained except on the IES, Intrusion and the POMS scales. Chemical disasters are associated with a wide variety of psychological, psychosocial, and physiological distress.

Acute Disease↗
PubMed1996

New directions for treatment research on sequelae of sexual abuse in persons with severe mental illness.

Sexual abuse in childhood is increasingly recognized as an important etiologic component in a number of psychiatric disorders. One-quarter to one-third of all female children suffer sexual abuse before their eighteenth birthday, and at least one half of women with severe mental illness acknowledge such events. An even higher percentage of a particularly vulnerable group, dually diagnosed homeless women, appear to have a premorbid history of childhood victimization. In this paper, we review the emergent literature on childhood abuse, its sequelae and treatment; and discuss the implications of these data for the development of new approaches to trauma recovery in people with severe mental illness.

Adult↗
PubMed1984

Neurologic sequelae following transcatheter embolization to control massive perineal hemorrhage.

A case of exsanguinating perineal hemorrhage resulting from rupture of a pseudoaneurysm of the right internal pudendal artery is presented. Transcatheter embolization of Gelfoam and wire coils proved to be life saving, but subsequent neurologic sequelae developed, including loss of sensation over the right side of the scrotum, penis, and medial thigh. Urinary incontinence developed as well. Fortunately, the paresthesias were temporary.

Aneurysm↗
PubMedDate not supplied

Stroke: non-motor sequelae, medical co-morbidity and patterns of intervention after referral to a special interest service.

Stroke poses a considerable financial burden on the health services as well as contributing to enormous personal suffering. A study was undertaken in 100 patients over 65 years old in a geriatric unit. Neuro-radiology confirmed cerebral infarcts in 91 and 89 per cent had additional neuro-medical problems. Specific sequelae of stroke occurred in 53 per cent of which 21 per cent related to dysphagia. Among various treatments 61 per cent were referred for physiotherapy and occupational and speech/language therapy. Knowledge of the nature and timing of complications is important in planning stroke services and the input of early medical specialist assessment has been shown to influence mortality and rehabilitation outcome.

Aged↗
PubMed1999

[Interventions in congenital heart disease and their sequelae in adults].

The advancements of cardiac surgery over the last decades led to larger numbers of patients with operated congenital heart diseases surviving into adulthood. In Germany it is estimated that over 120,000 adults have operated congenital heart diseases. Five to 7% of them will need yearly hospital admissions. Interventional procedures are additional tools used to treat these patients with various sequelae or residua (Table 1). In the following review we concentrate on 2 different interventional procedures: dilatation and stent implantations for treatment of stenosis and the different devices used for the closure of shunt lesions. For congenital valvular pulmonary stenosis, balloon dilatation is the therapy of choice regardless the age of the patient. Stent implantation for the treatment of peripheral pulmonary stenosis (e.g., after previous systemic pulmonary shunts) can decrease the need for redo surgery, which is accompanied with increased risk. Stent implantations proved also to be useful to treat stenoses after Mustard patch in patients with transposition of the great arteries, after Fontan procedures or dealing with the rare pulmonary venous stenosis. In contrast, dilatation of bioprosthesis and conduit stenosis are not promising. Balloon dilatation of valvular aortic stenosis is an accepted therapy in childhood up to adolescents. Table 2 compares a surgical series including many infants with critical aortic stenosis with a series of balloon dilatation in children and another one in adults regarding lethality, complications, and results. Table 3 illustrates the immediate and late results of balloon dilatation of aortic coarctation in 3 different studies. The high recurrence rate in infants made clinicians refrain from taking this age group for balloon dilatation. In children and adult patients, good results are reported (75% reduction of gradients). The complication rate is low (2.3 to 3.3%) and aneurysm formation rate seldom (1 to 7%). Stenosed aorto-pulmonary collaterals will rarely need balloon dilatation. Surgical closure of atrial septal defect is a low risk procedure with a very low rate of residual shunts (2%). Of the 5 available devices for transcatheter closure of atrial septal defect Type II, only 2 occluders are in use in Germany, the Clamshell and the Amplatzer device. The largest clinical studies of the different systems, their efficacy, complications and residual shunt rate are presented in Table 4. For the deployment of these occluders a TEE is always needed. There are many more systems in clinical use to close the patent arterial duct (PDA) (Table 5). The Ivalon plug as well as the Rashkind device have probably only historical value. Different types of coils (Gianturco, Cook detachable, PFM) are now in use worldwide. The reason for their widespread use, besides their easy application, is the fact that most coils are relatively cheap and need only small sheaths for deployment. Their further evaluation identified a residual shunt rate of 5% as well as a number of complications (embolization, hemolysis, stenosis of the left pulmonary artery) in 0 to 6%. For the large PDA the Amplatzer device has recently been introduced. An additional indication for the use of the different occluding devices are aorto-pulmonary collaterals, venovenous fistulae, pulmonary or coronary artery fistulae. Aorto-pulmonary collaterals are often associated with complex cardiac lesions and occasionally appear after palliative procedures. An excellent cooperation between adult and pediatric cardiologists is needed in order to offer the group of adults with congenital heart diseases an adequate and comprehensive management.

Adult↗
PubMed2002

Long-term sequelae of perinatal asphyxia in the aging rat.

Information on the consequences of perinatal asphyxia (PA) on brain morphology and function in the aging rat is missing although several groups have hypothesized that PA may be responsible for neurological and psychiatric deficits in the adult. We therefore decided to study the effects of PA on the central nervous system (CNS) in terms of morphology, immunohistochemistry, neurology and behavior in the aging animal. Hippocampus and cerebellum were evaluated morphologically by histological, immunohistochemical and magnetic resonance imaging and cerebellum also by stereological tests. Neurological function was tested by an observational test battery and rota rod test. Cognitive functions were examined by multiple-T-maze and the Morris water maze (MWM). Increased serotonin transporter (SERT) immunoreactivity in the CA2 region of the hippocampus and a significant difference in the escape latency, when the platform of the MWM was moved to a new location, were observed in asphyxiated rats. We showed that deteriorated cognitive functions accompanied by aberrant expression of hippocampal SERT and impaired relearning are long-term sequelae of perinatal asphyxia, a finding that may form the basis for understanding CNS pathology in the aging subject, animal or human.

Aging↗
PubMed2000

[Long-term toxic sequelae of the treatment of Hodgkin's disease].

In recent years, continuous optimization of therapy has decisively improved the prognosis of Hodgkin's disease. However, this improvement in overall survival has also led to an increase in several possible late effects which the clinician must be aware of. Due to the appearance of chronic fatigue symptoms, cardiopulmonary problems, hypothyreosis and damage to the gonadal system including azoospermia and ovarian insufficiency, the mostly young patients often suffer a persistent reduction in quality of life. In addition, the increased incidence of second malignancies following successful primary treatment presents a considerable problem. While complete remission and prolonged survival were previously the main objectives in the therapy of malignant lymphomas, reduction or avoidance of toxicity is now becoming more and more central. This development has led to the increasing importance of late sequelae and quality of life as endpoints in modern therapy trials in oncology.

Adult↗
PubMed2006

[Bright white vocal folds and capillary ectasias. Late sequelae after radiotherapy].

We report on visible laryngeal changes after radiotherapy. In this study, three women and two men aged 50-64 years were involved. In three cases, the primary tumor was a carcinoma of the thyroid gland and in one case a carcinoma of the esophagus. Due to dysplasia of the vocal folds, one patient underwent primary radiotherapy. Endoscopy was performed 4 to 22 years after radiotherapy. The larynx was examined by video-laryngoscopy and stroboscopy. We found a characteristic pattern of the vocal folds in all patients: bright white vocal fold surface, ectasia of capillaries and increased angiogenesis. We only found this pattern in patients after radiotherapy. In our opinion, these findings are late sequelae of radiotherapy. The picture of laryngitis due to radiotherapy can be distinguished from chronic laryngitis of other etiology using these criteria.

Adenocarcinoma, Follicular↗
PubMed2006

[Sequelae of hypertenson: kidney disease].

Nephropathy is one of the frequent sequelae of hypertension. Arterial hypertension causes both arterial and capillary changes in the kidneys as well as development of interstitial fibrosis. Systemic or intraglomerular pressure increase leads to albuminuria and proteinuria, which in turn contributes to further damage of the kidneys. Impairment of the kidneys due to hypertension can ultimately result in terminal renal insufficiency necessitating dialysis. Metabolic factors such as hyperlipidemia, hyperuricemia, hyperhomocysteinemia, and insulin resistance can aggravate renal lesions. Effective lowering of blood pressure in conjunction with management of the metabolic risk factors is decisive for prevention of chronic kidney disease, which in turn must be considered a factor involved in exacerbation of the hypertension.

Albuminuria↗
PubMed2000

[Pediatric arthroses as a sequelae of enchondral damage. Examples of frostbite, Kashin-Beck disease, rat bites and other etiologies].

PURPOSE: To review the similarities of the radiographic changes in frostbite, the Asian disease of Kashin-Beck, and long term growth damage from injury such as rate bite. MATERIALS AND METHODS: Radiographs and literature from subjects with these diagnoses were analyzed for the common features and differences. Included was an infant with hand changes 8 months after unwitnessed rat bites. RESULTS: Each condition revealed findings consistent with the hypothesis of localized damage to sites of enchondral ossification, including at acrophyses--the growth plates that are not between epiphysis and metaphysis, but instead lie at the margins of growth centers, including carpal and tarsal bones, and the non-epiphyseal ends of small tubular bones. DISCUSSION: The patterns observed support a final common pathway of damage in frostbite due to cold injury, Kashin-Beck disease (endemic in China) of unknown etiology, and damage from toxins associated, for example, with rat bite. In frostbite, the distribution is acral because of the site of exposure, while the distribution in Kashin-Beck is more diffuse and often less contiguous. In each condition, arthrotic sequelae may be expected in the natural course of follow-up. MRI may play a role in acute diagnosis that might modify the course of each disease.

Animals↗
PubMed1999

Case-control study of the pathogenesis and sequelae of symptomatic vertebral fractures in men.

To investigate the pathogenesis and sequelae of symptomatic vertebral fractures (VF) in men, we have performed a case-control study, comparing 91 men with VF (median age 64 years, range 27-79 years) with 91 age-matched control subjects. Medical history, clinical examination and investigations were performed in all patients and control subjects, to identify potential causes of secondary osteoporosis, together with bone mineral density (BMD) measurements. BMD was lower at the lumbar spine and all sites in the hip in patients with VF than in control subjects (p < 0.001). Potential underlying causes of secondary osteoporosis were found in 41% of men with VF, compared with 9% of control subjects (OR 7.1; 95% CI 3.1-16.4). Oral corticosteroid and anti-convulsant treatment were both associated with a significantly increased risk of VF (OR 6.1; 95% CI 1.3-28.4). Although hypogonadism was not associated with an increased risk of fracture, the level of sex hormone binding globulin was higher (p < 0.001) and the free androgen index lower (p < 0.001) in men with VF than control subjects. Other factors associated with a significantly increased risk of VF were family history of bone disease (OR 6.1; 95% CI 1.3-28.4), current smoking (OR 2.8; 95% CI 1.2-6.7) and alcohol consumption of more than 250 g/week (OR 3.8; 95% CI 1.7-8.7). Men with VF were more likely to complain of back pain (p < 0.001) and greater loss of height (p < 0.001) than control subjects, and had poorer (p < 0.001) scores for the energy, pain, emotion, sleep and physical mobility domains of the Nottingham Health Profile. We conclude that symptomatic VF in men are associated with reduced BMD, underlying causes of secondary osteoporosis such as corticosteroid and anti-convulsant treatment, family history of bone disease, current smoking and high alcohol consumption, and that they impair the perceived health of the individual.

Adrenal Cortex Hormones↗
PubMedDate not supplied

Pathological study of postcoronary arteritis in adolescents and young adults: with reference to the relationship between sequelae of Kawasaki disease and atherosclerosis.

To clarify whether the cardiac sequelae of Kawasaki disease (KD), postcoronary arteritis lesions can become a risk factor for atherosclerosis of the coronary arteries, six autopsy cases of patients older than 15 years of age with coronary arterial lesions caused by arteritis in childhood were examined histologically. Twenty-four arteries were inspected: 10 had no evidence of aneurysm formation, 7 arteries manifested simple dilatation of the lumen, and in 7 arteries there were aneurysms with recanalization. In the group in which there were no aneurysms, "new intimal thickening" was observed in addition to the preexisting intimal thickening which had been caused by arteritis in the acute phase of KD. In the second group with aneurysmal arteries whose lumen remained dilated, thrombotic occlusion occurred in 4 of 6 aneurysms. In addition, advanced atherosclerotic changes (i.e., complicated lesions) were found in a 39-year-old patient. Finally, in the third group of arteries which manifested recanalized lumens after thrombotic occlusion of the aneurysms, new intimal thickening was seen on the internal side and some of them were occluded. The findings in this study suggest that aneurysms present in coronary arteries in individuals with a history of KD constitute a risk factor for atherosclerosis later in life.

Adolescent↗