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PubMed1996

Cardiopulmonary sequelae after treatment for Hodgkin's disease: increased risk in females?

BACKGROUND: The treatment of Hodgkin's disease (HD) involves irradiation and chemotherapy. Both modalities may cause heart and lung injury. We aimed to assess 1) the occurrence of such injury, 2) the extent to which combined versus single-organ-affection resulted in disability, and 3) whether determinants for cardiopulmonary injury could be identified. PATIENTS AND METHODS: A national cohort (n = 116) of HD patients (mean age 37 +/- 7 (SD) years, 67 males) was examined by interview, echocardiography, bicycle exercise test and lung function tests, 5-13 years after mediastinal irradiation with or without chemotherapy. RESULTS: Cardiac, pulmonary or combined sequelae occurred, respectively, in 21%, 15% and 19% of the patients affecting 75% of the females versus 41% of the males (P < 0.001). Of the patients with combined sequelae, 27% were disabled versus 4% of the rest (P < 0.05). Combined sequelae was associated with dyspnoea (P < 0.001) and reduced maximal exercise heart rate (P < 0.05). Compared to males, females had an increased risk of heart valve regurgitation (46% versus 16%, P < 0.001), pericardial thickening (22% versus 10%, P = 0.07) and reduced gas transfer (41% versus 22%, P = 0.03). Female gender was a significant risk factor for cardiac and/or pulmonary sequelae (OR 6.1, 95% CI 2.4-15.7), whereas age, follow-up period, smoking habits, histology, bulky mediastinal disease, radiation dose and chemotherapy were not. Mean exercise work capacity and O2-saturation were within normal limits. CONCLUSIONS: Although cardiac and/or pulmonary sequelae were detected in more than half of the patients, only combined injury was associated with disability, dyspnoea and reduced performance. Females had an increased risk of cardiopulmonary sequelae, which could not be explained by treatment-related differences between the genders.

Adult↗
PubMed2000

The isolated burned palm in children: epidemiology and long-term sequelae.

The isolated burn of the palm is a typical injury in young children. Positioning and splinting in small hands is difficult, and long-term sequelae of these injuries are not uncommon. The objective of the present study was to assess the outcome of palm burns and to identify the risk factors for long-term sequelae. All patients admitted to our hospital affected with isolated palm injuries between January of 1988 and January of 1998 were reviewed. In total, 120 pediatric patients were admitted with isolated palm burns; 110 patients (91.7 percent) had partial-thickness burns, and 10 patients (8.3 percent) had full-thickness burns. Only four patients (3.3 percent) required excision and skin autografting, but all patients whose palms were operated on in the acute phase developed burn contractures. Sixteen patients (13.3 percent) developed palmar contractures, and more than half of them (56 percent) required reconstructive procedures. All palm burns that healed in more than 3 weeks developed scarring and sequelae (p<0.05 compared with no sequelae). Pediatric palmar burns are benign injuries with a low incidence of late sequelae. However, flame and contact burns are more prone to develop scarring. Excision and autografting should be performed on wounds that take over 3 weeks to heal, but it does not prevent late sequelae.

Burns↗
PubMed2005

Mortality among persons with a history of Kawasaki disease in Japan: can paediatricians safely discontinue follow-up of children with a history of the disease but without cardiac sequelae?

AIM: To clarify the question of whether patients with Kawasaki disease suffer a higher mortality rate after the incidence of the disease in comparison with age-matched healthy individuals. METHODS: Between July 1982 and December 1992, 52 collaborating hospitals collected data on all patients having a new, definite diagnosis of Kawasaki disease. Patients were followed up until 31 December 2001 or their death. The expected number of deaths was calculated from Japanese vital statistics data and compared with the observed number. RESULTS: Of 6576 patients enrolled, 29 (20 males and 9 females) died. The standardized mortality ratio (SMR: the observed number of deaths divided by the expected number of deaths based on the vital statistics in Japan) was 1.15 (95% CI: 0.77-1.66). In spite of the high SMRs during the acute phase, the mortality rate was not high after the acute phase for the entire group of patients. Although the SMR after the acute phase was 0.75 for those without cardiac sequelae, six males (but none of the females) with cardiac sequelae died during this period; and the SMR for the male group with cardiac sequelae was 1.95 (95% CI: 0.71-4.25). The mortality from congenital anomalies of the circulatory system was elevated, but no increase in cancer deaths was observed. CONCLUSION: Although it was not statistically significant, the mortality rate among males with cardiac sequelae due to Kawasaki disease appeared to be higher than in the general population. On the other hand, the mortality rates for females with the sequelae and both males and females without sequelae were not elevated.

Child↗
PubMed1998

Cardiac sequelae of Kawasaki disease among recurrent cases.

OBJECTIVE: This study was undertaken to clarify whether cardiac sequelae due to Kawasaki disease are more frequent among recurrent cases than initial onset cases. STUDY DESIGN: A cross sectional study using data from nationwide surveys of Kawasaki disease in Japan was conducted. A total of 33,976 patients reported were divided into two groups: initial onset cases (32,923 patients) and recurrent cases (1053 patients). Proportions of cardiac sequelae such as coronary aneurysms/dilatation, coronary stenosis/narrowing, myocardial infarction, and valvular lesions were compared between the two groups. RESULTS: The proportions of patients with the sequelae were significantly more common among recurrent cases. In men 25.5% of the recurrent cases had the sequelae in comparison with 14.9% for initial onset cases, and in women 16.1% of recurrent cases had the sequelae compared with 9.8% of initial onset cases. Giant coronary aneurysms were twice as likely in men in whom the disease was recurring than in initial onset cases, and 1.5 times more likely in women in whom the disease was recurring than in initial onset cases. CONCLUSION: Cardiac sequelae of Kawasaki disease are more likely to appear on recurrent case patients.

Child↗
PubMed1999

Permanent sequelae in sports injuries: a population based study.

AIM: To identify permanent sequelae after sports injuries in children and adolescents. METHODS: In 1985, a prospective register was drawn up of all sports related injuries reported that year by the residents of Trieste, Italy aged 6-15 years. Moderate to severe injuries (scoring >/= 2 on the abbreviated injury scale (AIS)) were the object of a longitudinal clinical study. In 1988, 30.9% of the 220 subjects enrolled had sequelae. A further follow up was undertaken in 1997. RESULTS: The follow up in 1997 involved 54 subjects (26 girls; average age 24.5 years). Subjective and objective sequelae, by now considered to be permanent, were found in 61.1%, corresponding to 15% of the AIS >/= 2 injuries recorded in 1985. The prevalence of sequelae was similar in the two sexes, in relation to the child's age at time of injury, and in the different sports practised. It was higher in relation to the severity of the lesion (89% of AIS 3 injuries examined, 56% of AIS 2 injuries) and to the type of lesion and its location. With regard to AIS >/= 2 injuries, permanent sequelae were found in 50% of ankle fractures, 43% of elbow fractures, 33% of leg/foot fractures, 25% of knee sprains, and 23% of ankle sprains. CONCLUSIONS: The frequency of sequelae in sports injuries in children and adolescents is high. The risk appears to be connected to certain anatomical and functional age characteristics. Prevention strategies should include specific assessment of physical fitness and adequate follow up after the accident, particularly rehabilitation.

Adolescent↗
PubMed1995

Evaluation of outcome of delayed neurologic sequelae after carbon monoxide poisoning by technetium-99m hexamethylpropylene amine oxime brain single photon emission computed tomography.

Using brain computed tomography (CT) and single photon emission computed tomography (SPECT) with technetium-99m hexamethylpropylene amine oxime (99mTc HM-PAO) in 13 patients with delayed neurologic sequelae after carbon monoxide poisoning, we tried to evaluate the clinical outcome of delayed CO sequelae. Among the 13 initial brain CTs, seven showed low density in the cerebral white matter and one revealed hypodensity in both globi pallidi. Of the 7 follow-up CT scans, 3 have remained unchanged, but in 4 cases more aggravating patterns with cortical atrophy without the clinical correlation were observed. There was no correlation between the CT findings and the outcome of delayed CO sequelae. All initial SPECTs in 13 patients with delayed CO sequelae showed diffuse patchy hypoperfusion throughout the cerebral cortex. Among the follow-up SPECTs in 7 patients, 6 patients showed increased cerebral perfusion with the concomitant clinical improvement, but the SPECT of a patient in bedridden state had remained unchanged, compared with the initial SPECT. There seemed to be good correlation between the findings of SPECT and the outcome of delayed CO sequelae. In conclusion, 99mTc HM-PAO brain SPECT is more sensitive than CT, and may be a useful test in evaluating the clinical outcome of delayed neurologic sequelae after CO poisoning.

Adult↗
PubMed1994

Risk factors for otitis media sequelae and chronicity.

Otitis media (OM) is a very common childhood illness, with identified risk factors for chronicity and recurrence. Although a few treatment studies have described clinical factors that predict increased morbidity, there is little information on risk factors for middle ear sequelae of OM. These conditions have an estimated annual incidence of 0.5% to 4% among children with chronic OM with effusion. Prospective studies to identify risk factors for sequelae, although usually preferred by researchers, are expensive to conduct and impractical for rare conditions such as cholesteatoma. Knowledge of risk factors for chronicity and sequelae can be used clinically to target high-risk children for earlier, more aggressive therapy or more frequent surveillance and testing to prevent sequelae and increase early detection of these conditions. A clinician's advice about modifiable risk factors may motivate parents to decrease their child's exposure to factors that increase the risk of OM, OM chronicity, and sequelae. Research is needed to identify risk factors for OM sequelae by means of well-designed controlled studies.

Adolescent↗
PubMed1996

Disease course and late sequelae of Langerhans' cell histiocytosis: 25-year experience at the University of California, San Francisco.

PURPOSE: The purpose of our investigation was to correlate the extent and degree of organ involvement at presentation of Langerhans' cell histiocytosis (LCH) with subsequent disease course, survival, and late sequelae. MATERIALS AND METHODS: The medical records of 71 patients with a pathologic diagnosis of LCH, age 0 to 21 years, who presented between January 1, 1969 and June 30, 1994, were reviewed for organ involvement at diagnosis, treatment, disease course, and late sequelae. Supplementary data were obtained by mailed questionnaire. RESULTS: The median follow-up time from diagnosis for all patients was 8.1 years. Involvement at diagnosis included nine patients with skin-only disease, 22 with monostotic disease, 12 with polyostotic disease, and 28 with multisystem presentation. Treatment was surgery only in 17 and chemotherapy and/or radiotherapy in 54 patients. Recurrences were seen in 35 patients, with the highest rate in the polyostotic group. Ten patients died: seven with the multisystem presentation, two with monostotic disease, and one with skin-only disease. Causes included progressive LCH (n = 6) and late sequelae of either treatment (n = 3) or disease (n = 1). Late sequelae were seen in 64% of 51 patients with more than 3 years of follow-up data. The most common were skeletal defects in 42%, dental problems in 30%, diabetes insipidus in 25%, growth failure in 20%, sex hormone deficiency in 16%, hypothyroidism in 14%, hearing loss in 16%, and other CNS dysfunction in 14%. The overall estimated survival rates at 5, 15, and 20 years are 88%, 88%, and 77%, with an estimated event-free survival rate of only 30% at 15 years. CONCLUSION: Despite the favorable survival, more than half of LCH patients will have further dissemination of disease or late sequelae, including even some patients with single-system disease at diagnosis. Future treatment needs to be designed to prevent disease progression and late sequelae.

Adolescent↗
PubMed2004

Sequelae from meningococcal meningitis in children: a critical analysis of dexamethasone therapy.

OBJECTIVE: To evaluate the effectiveness of dexamethasone as an adjunctive therapy to antibiotics in children with meningococcal meningitis. METHOD: A total of 81 children diagnosed with meningococcal meningitis hospitalized in sequence were studied at the University Hospital of São Paulo University, with the objective of evaluating the presence of sequelae in four different groups of patients, following the administration of dexamethasone: Group I - 25 patients who received the first dose at least 10 minutes before the introduction of the antibiotic therapy; Group II - 19 patients who received the corticosteroid concomitantly; Group III - 14 patients for which the dexamethasone was administered after beginning the antibiotic scheme; Group IV - 23 patients that did not receive dexamethasone. The groups were evaluated for homogeneity through the prognostic indexes and clinical and laboratory characteristics, based on the records obtained at hospitalization. RESULTS: Some degree of sequelae occurred in 16 (26.22%) of the survivors and 23 patients (28.39%) coursed with sequelae or died. The mean period of neurological attendance was 36.97 months and neurological alterations were detected in 16.17% of the patients. No significant difference was found between the four groups. There was also no statistical difference in the comparison of the neurological sequelae in the children from group IV with the children of groups I and II or even with groups I, II and III analyzed as a whole. The presence of hearing loss occurred in 11.11% of the patients, again there was no significant difference between the four groups. Psychological evaluation was performed using the WPSSI and WISC tests. A mild mental disability was detected in one patient from group I and another in group III. The overall analysis of the sequelae (neurological, auditory and intellectual level) also did not demonstrate any significant difference between the four groups. Comparing the children from groups I and II together and also groups I, II and III as a whole with the children in group IV also failed to detect a significant difference arising from the use or nonuse of the corticosteroid. CONCLUSION: Dexamethasone was not proven to be effective in decreasing the number of sequelae among patients with meningococcal meningitis.

Anti-Bacterial Agents↗
PubMed2000

Mortality among persons with a history of Kawasaki disease in Japan: existence of cardiac sequelae elevated the mortality.

OBJECTIVE: To clarify whether patients with Kawasaki disease have a higher death rate than the age-matched healthy population after the disease occurrence. STUDY DESIGN: Between July 1982 and December 1992, 52 collaborating hospitals collected data on all patients having a new definite diagnosis of Kawasaki disease. Patients were followed until December 31, 1997, or death. The expected number of deaths was calculated from Japanese vital statistics data and compared with the observed number. RESULTS: Of 6576 patients enrolled, 25 (19 males and 6 females) died. The standardized mortality ratio (SMR) was 1.35. In spite of the high SMRs during acute phase, the mortality rate was not high after the acute phase for all patients. Although the SMR after the acute phase was 0.76 for those without cardiac sequelae, 6 males (no females) with cardiac sequelae died during this period and the SMR for the male group with cardiac sequelae was 2.77. CONCLUSION: The mortality rate among males with cardiac sequelae due to Kawasaki disease was 2.8 times as high as in general population, whereas mortality rates for females with the sequelae and both males and females without sequelae were not elevated.

Adolescent↗
PubMed1999

Long-term sequelae of spontaneous axillary-subclavian venous thrombosis.

BACKGROUND: The frequency and severity of post-thrombotic sequelae after spontaneous axillary-subclavian venous thrombosis remain poorly known. OBJECTIVE: To determine the late sequelae of conventionally treated spontaneous axillary-subclavian venous thrombosis. DESIGN: Cross-sectional study. SETTING: University department of vascular medicine. PATIENTS: 54 patients seen during an 18-year period (mean follow-up, 5 years). MEASUREMENTS: Scores for the severity of post-thrombotic symptoms were graded on a numerical rating scale ranging from 0 to 10 and on a 6-point verbal rating scale. Ultrasonographic sequelae were classified as grade 0, normal flow; grade 1, moderate obstruction; or grade 2, severe obstruction or occlusion. RESULTS: Verbal scores were "nil/negligible" in 47% of patients and "severe/intolerable" in 13%; numerical scores were 0 to 3 in 78% of patients and 7 to 10 in 9%. Grade 2 ultrasonographic sequelae were found in 22% of cases. No relation was seen between ultrasonographic sequelae and symptom severity scores. CONCLUSION: The overall clinical outcome of spontaneous axillary-subclavian venous thrombosis is good, and there is no relation between the severity of late symptoms and ultrasonographic sequelae.

Adolescent↗
PubMedDate not supplied

[Risk factors predictive of neurological sequelae in term newborn infants with perinatal asphyxia].

INTRODUCTION: Perinatal asphyxia (PA) and its neurologic manifestations are the most important cause of brain injury and neurologic sequelae in full-term infants. The objective of this study is to analyze the perinatal risk factors of neurologic sequelae in asphyctic term newborns. PATIENTS AND METHODS: One hundred and fifty-six consecutive asphyctic term infants were studied prospectively during 40 months. PA was graded in two stages (severe and non-severe), hypoxic-ischemic encephalopathy classification was based on Levene's criteria, and neurologic sequelae was based on Finer and Amiel-Tisson's criteria. The perinatal variables were graded as prenatal (gestational and obstetrics), neonatal (resuscitation, general data of the newborn, and organic manifestations of asphyxia) and postneonatal (neurologic sequelae with at least 24 months of follow-up). The relationships between these variables are studied by univariant and multivariant analysis (Cox's regression). RESULTS: PA was graded as severe in 31 cases and non-severe in 125. Neurologic manifestations (hypoxic-ischemic encephalopathy) during neonatal period were present in 25.6%, and extraneurologic manifestations (hypoxic-ischemic disease) in 41.7% cases. The incidence of neurologic sequelae, in 115 asphyxiated full-term infants follow-up at least 24 months, was 16.5% (19 cases). The perinatal variables associated to risk of neurologic sequelae on univariate analysis are variables of neonatal resuscitation (1 minute Apgar score < or = 4, 5 minute Apgar score < or = 6, endotracheal intubation, severity of PA) and variables of systemic manifestations (hypoxic-ischemic encephalopathy, cardiovascular and multi-systemic dysfunction, and mechanical ventilation). But only two variables are independently associated on multivariate analysis: severe PA (RR = 2.82; IC = 1.07-7.39) and hypoxic-ischemic encephalopathy (RR = 4.17; IC = 1.48-11.75). CONCLUSIONS: The best predictive risk factors for the neurological prognosis at follow-up are severe PA at birth and/or evidence of encephalopathy in neonatal period.

Acidosis↗
PubMed1956

Sequelae of encephalitis; report of a study after the California epidemic.

In a study of almost 500 patients to determine residual effects, the sequelae of both St. Louis and Western equine encephalitis were more prominent in the younger age group. Infants under three months with Western equine encephalitis had the greatest central nervous system damage. Forty-four per cent of this entire group had sequelae. In patients between one and four years of age, the incidence of sequelae was less. The Western equine infection was associated with the more disabling residual damage. Postencephalitic convulsions were fairly common in the younger patients with Western equine disease, but not in the St. Louis group. After the age of five the sequelae rate dropped. In all age groups the Western equine residual changes were more severe than the damage of St. Louis infection. Some infants, children and adults showed remarkable improvement from sequelae even as much as two years after the abnormalities occurred. With the longer period of follow-up, some late sequelae were noted in children and adults, primarily among those who had Western equine infection.

Adult↗
PubMed1991

Cardiac sequelae of Kawasaki disease in Japan: statistical analysis.

The proportions of Kawasaki disease patients with cardiac sequelae in Japan were analyzed using nationwide survey data from the 6 1/2-year period July 1982 through December 1988. Of 46,864 cases of Kawasaki disease reported in the surveys, 7637 or 16.3% had cardiac sequelae such as dilation or stenosis of coronary arteries, myocardial infarction, and valvar lesions 1 month or more after onset. The prevalence of cardiac sequelae was particularly high in males, infants younger than 1 year, and children older than 5 years of age. In sequential observation, there was no correlation between the prevalence of cardiac sequelae and periods of high or low incidence of the disease. The prevalence of cardiac sequelae overall declined steadily over the observation period, perhaps as a consequence of increasing use of intravenous gamma globulin. However, children older than the age of 5 years manifested increasing prevalence of cardiac sequelae over the observation period, probably as a result of lower rates of intravenous gamma globulin administration.

Child↗
PubMedDate not supplied

A comparison of the incidence of transient bacteremia and infectious sequelae after sclerotherapy and rubber band ligation of bleeding esophageal varices.

A comparison of the incidence of transient bacteremia and infectious sequelae in patients undergoing sclerotherapy and those undergoing variceal ligation has not yet been reported. Fifty patients admitted with acute esophageal variceal bleeding were treated with sclerotherapy between July 1990 and July 1991. Fifty-five patients were treated with banding ligation between July 1991 and July 1992. Blood cultures were taken before and 5 minutes, 30 minutes, and 24 hours after treatment to compare the incidence of transient bacteremia in each group. The incidence of infectious sequelae during hospitalization was also compared. Transient bacteremia occurred in 17.2% of the sclerotherapy group and in 3.3% of the ligation group (p < 0.03). Infectious sequelae occurred in 18% of the sclerotherapy group and 1.8% of the ligation group (p < 0.01). Apart from bacteremia, the most frequently encountered infectious sequela was spontaneous bacterial peritonitis. Both transient bacteremia and infectious sequelae are more likely to develop when liver disease is severe. Two patients in the sclerotherapy group but none in the ligation group died of infectious sequelae. The incidence of transient bacteremia and infectious complications after sclerotherapy for acute variceal bleeding is about 5 to 10 times greater than that after variceal ligation. Inasmuch as it is equally effective and entails fewer infectious complications, variceal ligation is preferable to sclerotherapy for patients with acute variceal bleeding. Further randomized trials are needed.

Acute Disease↗
PubMed1996

Positive and negative psychosocial sequelae of bone marrow transplantation: implications for quality of life assessment.

Life-threatening disease can trigger positive effects such as greater appreciation for life and enhanced interpersonal relationships. Little research has examined these salutary effects or their association with quality of life (QOL). Adult bone marrow transplantation (BMT) survivors (n = 90) were interviewed regarding psychosocial sequelae of BMT and completed indices of QOL and psychological adjustment. Thematic analysis was used to code interview responses into discrete categories of negative and positive sequelae. Multiple regression analyses indicated POSTOTAL scores were inversely associated with time post-BMT and positively associated with negative prognostic factors at BMT. Scores on indices of QOL and psychological adjustment were significantly correlated with reports of negative post-BMT sequelae but unrelated to positive sequelae. It was concluded that life-threatening disease can trigger positive sequelae that can contribute to QOL. However, standard QOL indices may not measure this positive QOL dimension, thus yielding a potentially incomplete picture of current QOL.

Adaptation, Psychological↗
PubMed1998

Post-infectious bronchiolitis obliterans: clinical, radiological and pulmonary function sequelae.

Background. There are few data on clinical, chest radiograph (CXR) or pulmonary function sequelae in children with post-infectious bronchiolitis obliterans (BO) (pulmonary crepitations, abnormalities on CXR, CT, nuclear medicine scans, or bronchography, with a history of past pulmonary infection and in the absence of other underlying pathology). Objective. To analyse the methodology of diagnosis, long-term clinical imaging and pulmonary function sequelae of post-infectious BO in children. Materials and methods. Imaging (CXRs, CT and nuclear lung scans) and clinical histories of 19 children were analysed. Results. Clinical follow-up (mean 6.8 years), revealed a high incidence of continuing problems (asthma and bronchiectasis). Fixed airway obstruction was the most common pulmonary function sequela. The sequelae on follow-up (mean 5.8 years) CXR were classified into five patterns which are illustrated: unilateral hyperlucency of an enlarged lung/part of lung; complete collapse of the affected lobe; unilateral hyperlucency of a small or normal-sized lung; bilateral hyperlucent lungs and a mixed pattern of persistent collapse, hyperlucency and peribronchial thickening. Conclusion. Long-term observations in children with post-infectious BO should be undertaken to detect bronchiectasis and obstructive airway disease. Sequelae evident on CXR, other than those previously described, can be found. Bronchography and/or lung biopsy are not usually required for the diagnosis of post-infectious BO.

Bronchiolitis Obliterans↗
PubMed1999

Factors related to cardiac sequelae of Kawasaki disease.

Among the 35.210 patients with Kawasaki disease who were reported in nationwide surveys from 1991 to 1996, 83% were treated with gamma-globulin (GG). Those treated with a total dose of 1000 mg/kg (9098 patients) and 2000 mg/kg (7012 patients) were selected as the subjects of the study on the relationship between the development of cardiac sequelae, in particular of giant aneurysms, and related factors using logistic regression models. Among the two groups that received 1000 mg/kg and 2000 mg/kg, respectively, the odds ratios for cardiac sequelae were significantly high for males, those < 6 months and > or = 7 years of age, and typical or recurrent cases. Except for those < 6 months of age, the odds ratios of all the factors mentioned above were higher for the incidence of giant coronary aneurysms than those for cardiac sequelae. The preventive effects of GG therapy for cardiac sequelae and in particular giant aneurysms, were significantly low when GG administration was initiated on day 8 or later after onset. In the group treated with 1000 mg/kg, the preventive effect was low when GG administration was spread over 3 days or longer. To prevent the development of cardiac sequelae, in particular giant coronary aneurysms, gamma-globulin therapy should be started as soon as possible and be completed within 2 days.

Child↗