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PubMed1991

Psychological sequelae of infertility treatment: the role of gender and sex-role identification.

Infertility has traditionally been viewed as a female problem and women have been expected to suffer greater psychological distress due to infertility. This paper investigates the nature of gender differences and sex-role identification in the psychological sequelae associated with infertility treatment. The expectation that infertile women experience higher distress levels than men was not supported by these data. No gender differences were observed in either the level of emotional strain, marital adjustment, or sexual satisfaction for the 104 couples studied. However, gender differences were apparent in factors associated with psychological distress, suggesting that while the level of strain might be comparable, the experience of infertility is different for men and women. Sex-role identification was found to have a greater relationship to the indices of distress than gender. Masculinity was associated with lower emotional strain and greater marital satisfaction for both genders and enhanced sexual satisfaction for men. Femininity was related to enhanced marital and sexual satisfaction for both genders. Gender differences and sex-role identification are discussed in the context of the unique experience of infertility.

Female↗
PubMed1992

Evaluation of dexamethasone for reduction of postsurgical sequelae of third molar removal.

Sixty patients with bilaterally symmetrical impacted third molars participated in this double-blind, within-subject study to quantify the effects of 4 mg of dexamethasone on reducing postsurgical sequelae. Each patient's surgery was staged by mouth side and completed in two appointments 5 to 6 weeks apart. A preoperative dose of dexamethasone given intravenously was randomized to mouth side and surgical appointment; sterile water served as a control. Major areas assessed in this study were facial swelling, pain, and trismus. No difference in swelling and daily pain was noted. However, trismus and global pain were significantly affected by the steroid. Patients had a daily postsurgical increase in incisal opening of 4 to 6 mm over the control side during the examination period. Patients evaluated pain by choosing the least painful side. By a greater than 4:1 margin, patients chose the steroid side as the least painful side. No increase in the rate or type of complications was detected between control and steroid sides.

Adolescent↗
PubMed1985

Sequelae of sural nerve biopsies.

Sequelae of sural nerve biopsy were examined in 24 patients. Fourteen subjects reported persisting pain or dysaesthesias for more than one year. In nine patients the symptoms were mild, in five severe. Hypaesthesia of the lateral aspect of the foot was found in 17 out of 18 patients with otherwise normal or only slightly impaired sensory function. In one patient sural nerve biopsy did not cause permanent sensory loss. Pain and dysaesthesia were not significantly related to post-biopsy or generalized hypaesthesia.

Adolescent↗
PubMed1990

Long-term sequelae of brain damage from closed head injury in children and adolescents.

A study was made of the sequelae of brain damage in young patients. Seventy patients between 4 and 18 years, admitted under the diagnosis "diffuse brain contusion", have been followed at least two years after head injury. The degree of function impairment in the fields of motor skills, cognition and behaviour was recorded. It was found that many patients with neurologically little or no function loss, nevertheless after the accident did suffer from psychosocial problems in the realm of family life, school or profession. Based on these findings, the authors recommend a consequent and systematic follow up of patients if they have been in coma for more than 1 hour, the objective being the early assessment of such dysfunctions, followed by adequate assistance.

Adolescent↗
PubMed1987

Convulsant action of morphine, [D-Ala2, D-Leu5]-enkephalin and naloxone in the rat amygdala: electroencephalographic, morphological and behavioural sequelae.

Morphine hydrochloride (25-200 nmol), [D-Ala2, D-Leu5]enkephalin (10-200 nmol) and naloxone hydrochloride (100-1000 nmol) were injected unilaterally into the rat amygdala and the following electrographic, behavioural and neuropathological responses were studied. Microinjections of low doses of morphine (25-50 nmol) resulted in behavioural alterations characterized by staring, gustatory automatisms and wet shakes, whereas higher doses additionally produced motor limbic seizures and status epilepticus. The first changes in the electroencephalogram appeared in the amygdala immediately after the administration of morphine and rapidly spread to hippocampal and cortical areas. Electrographic alterations consisted of high voltage fast activity, spiking, bursts of polyspiking, electrographic seizures and periods of postictal depression. Neuropathological analysis of frontal forebrain sections by means of light microscopy revealed widespread, seizure-related damage confined to amygdala, olfactory cortex, thalamus, hippocampal formation, neocortex and substantia nigra. Pretreatment of animals with naloxone, 2-20 mg/kg s.c., as well as simultaneous microinjection of the non-convulsant dose of naloxone, 100 nmol, with morphine, 100 nmol, into the amygdala failed to block the development of convulsant activity and seizure-related brain damage produced by the opiate. In contrast, diazepam, 10 mg/kg i.p., when administered prior to the microinjection of morphine into the amygdala, abolished the epileptogenic effects of the drug. [D-Ala2, D-Leu5]Enkephalin, 10-200 nmol, elicited electrographic and behavioural responses similar to those seen after low doses of morphine, when administered into the amygdala. High voltage fast activity, single spikes, bursts of polyspiking, electrographic seizures and periods of postictal depression were seen in the electroencephalogram, but no behavioural signs of motor limbic seizures could be detected. The only behavioural correlates of epileptiform electrographic activity were wet shakes, myoclonic head twiches and gustatory automatisms. The examination of frontal forebrain sections from rats receiving [D-Ala2, D-Leu5]enkephalin revealed no morphological changes. Pretreatment of rats with either naloxone, 2 mg/kg, or diazepam, 10 mg/kg, blocked the development of behavioural and electrographic sequelae of the peptide. Naloxone, 100-1000 nmol, when microinjected into the amygdala, produced electrographic, behavioural and morphological alterations resembling those seen after high doses of morphine.(ABSTRACT TRUNCATED AT 400 WORDS)

Amygdala↗
PubMed1985

Late cardiac, thyroid, and pulmonary sequelae of mantle radiotherapy for Hodgkin's disease.

Cardiac, thyroid and pulmonary function were evaluated in 25 patients aged 35 years or under, treated for Hodgkin's disease by mantle radiotherapy 5-16 years previously. No patient had symptoms of heart disease. Although thallium myocardial perfusion scintigraphy was normal in all patients, abnormalities of myocardial function were detected in 6 (24%) patients using gated equilibrium rest and exercise radionuclide ventriculography. Resting left ventricular ejection fraction (LVEF) was abnormal in 1 patient, and in 3 patients there was an abnormal LVEF response to exercise. All 6 patients had right ventricular dilatation. Apical hypokinesia was present in 4 of these patients. A small asymptomatic pericardial effusion was detected by M-Mode echocardiography in only 2 (8%) patients. Twenty-three (92%) patients had evidence of abnormal thyroid function. Two (8%) patients had become clinically hypothyroid. Serum TSH was elevated in 13 (52%) patients and TRH stimulation test was abnormal in a further 10 (40%) patients in whom TSH was normal. Pulmonary function studies showed a moderate decrease in diffusing capacity (72% of predicted) and a minor reduction in lung volume. Although a high incidence of cardiac, thyroid and pulmonary abnormalities was detected, only the 2 patients who had become hypothyroid were symptomatic. Modification of the irradiation technique may reduce the incidence of cardiac abnormalities, but is unlikely to alter significantly the thyroid or pulmonary sequelae.

Adult↗
PubMed1986

Radiotherapeutic prophylaxis of estrogen-induced gynecomastia: a study of late sequela.

Radiation therapy is an effective means of preventing the development of hormone-induced gynecomastia in men with cancer of the prostate. The efficacy and morbidity of this type of radiation was studied in a retrospective analysis of 87 patients referred for treatment from 1972 to 1982. Patients receiving DES as treatment for prostate carcinoma were treated with irradiation to the breast tissue. Patients were treated with 4 MV, 60Co superficial X rays. Doses range from 1200 to 1500 cGy in 3 fractions. The majority of patients had satisfactory results in terms of prevention of gynecomastia and mammalgia. There were few acute reactions noted and no evidence of long term sequela.

Aged↗
PubMed1992

A survey of prevention and treatment regimens for oral sequelae resulting from head and neck radiotherapy used in Dutch radiotherapy institutes.

Radiation treatment plays an important role in the management of head and neck cancer. Unfortunately several radiation-induced side effects may occur including mucositis, hyposalivation, radiation caries, trismus and osteoradionecrosis. It is generally accepted that most side effects can be prevented or reduced in severity. The purpose of this investigation was to make a survey of the prevention and treatment regimens for oral sequelae resulting from head and neck radiotherapy applied in all radiotherapy institutes in the Netherlands, and to evaluate the differences in these regimens. In all Dutch centers (n = 20) in which irradiation of head and neck cancer patients is performed, members of the staff responsible for prevention and treatment of oral side effects were interviewed. Questions referred to composition of the dental team, screening and care pre-irradiation, care during irradiation, and care post-irradiation. There appeared to be a great diversity in the preventive approach of the head and neck cancer patient in Dutch radiotherapy institutes. The most comprehensive counseling was performed by those centers in which a dental team was active, particularly when an oral hygienist was a member of such a team. The diversity is among others based on lack of well-defined guidelines in many centers, the spread of a relatively small patient group over a rather large number of centers, absence of a dental team in some centers, absence of an oral hygienist in some dental teams, and the observation that a rather large number of patients were not referred, or not timely referred to the dental team. There seems to be a need for the development of a general protocol for the prevention of oral complications applicable in all centers.

Dental Caries↗
PubMed1992

Long-term neuropsychologic sequelae of childhood leukemia: comparison of two CNS prophylactic regimens.

To compare the late neuropsychologic toxicities of CNS prophylaxis in childhood acute lymphoblastic leukemia (ALL), a transversal assessment was performed in two groups of ALL patients and two control groups. The ALL patients had received one of the following CNS prophylaxes: cranial irradiation, 24 Gy and i.t. MTX 10 mg/m2, 6 doses (RT group, n = 25) or i.t. Ara-C 30 mg/m2 and i.t. MTX 10 mg/m2, 10 doses (ChT group, n = 29). The two control groups were: Siblings (Sb, n = 24) and Solid Tumors (ST, n = 22). Intelligence Quotient (IQ), memory, learning, attention and frontal tasks were studied. Comparative analyses between ChT and RT showed no differences in any of the tests. When RT was compared with ST or Sb, RT showed a 10-point lower mean IQ (p greater than 0.05). The results of ChT versus ST or versus Sb were worse in the ChT group. In many tests the differences were statistically significant. Analyses of the 54 ALL patients compared with the 46 controls showed significant differences in all tests except verbal memory and verbal learning. Neuropsychological sequelae of CNS prophylaxis are discussed, and in particular, the role of cranial radiotherapy and i.t. Ara-C. We conclude that prophylactic CNS therapy may cause cognitive dysfunctions.

Adolescent↗
PubMed1995

Neutron irradiation of human pelvic tissues yields a steep dose-response function for late sequelae.

PURPOSE: Analysis of the dose-response function in normal tissues following pelvic irradiation for carcinoma of the prostate. METHODS AND MATERIALS: A homogeneous group of 136 patients with locally advanced carcinoma of the prostate were treated with the Fermilab high-energy neutron beam at three dose levels: 19, 20.4, and 21 Gy, using the same treatment plan and fractionation scheme for all patients. RESULTS: Tumor control rates were about 83% at the three dose levels studied. However, the normal tissue complication rate (late sequelae) varied with dose: 0 out of 5 at 19 Gy, 5 out of 58 (8.6%) at 20.4 Gy, and 9 out of 73 (12.3%) at 21 Gy. CONCLUSIONS: Neutron therapy to the pelvis reveals a steep dose-response function for late effects with a coefficient of variation of only 11%. This is lower than that usually observed with photons or with less uniform clinical data sets, and may be characteristic for well-planned high-LET radiotherapy.

Adult↗
PubMed1995

Late normal tissue sequelae from radiation therapy for carcinoma of the tonsil: patterns of fractionation study of radiobiology.

PURPOSE: To evaluate the influence of dose fractionation and other factors on the development of late complications in mandibular bone, muscle, and mucosa of the oral cavity after external beam radiation therapy for carcinoma of the tonsil. METHODS AND MATERIALS: A retrospective analysis was made of the results in 676 patients treated with a spectrum of fractionation regimens in nine centers during the years 1976-1985. Only severe (Grades 3-4) late complications were analyzed. RESULTS: With more than 5 years follow-up, it was found that total dose was a factor for all three types of complications, but that in other respects, the radiobiology of late-(> 3 months) developing mucosal ulcerations was different from that for mandibular necrosis and muscle injury. Dose per fraction was a significant factor for bone and muscle (estimated alpha/beta values of 0.85 Gy and 3.1 Gy, respectively). By contrast, mucosa showed no influence on response from change in fraction size over the range of approximately 1.0-3.5 Gy. Complications in bone and muscle were not related to overall treatment duration, whereas there was a significant inverse relationship for mucosa breakdown. The rate of development of complications was fastest in mucosa and slowest in bone. The appearance of complications by 4 years after treatment was about 80% of those developing by 8 years in the mucosa, 66% in muscle, and about 50% in bone. The high alpha/beta ratio, inverse relationship with overall treatment duration, and faster development of mucosal complications suggests that they may develop as a consequence of earlier mucosal injury. As anticipated, adequate retrospective analysis of acute complications could not be made even when objective criteria such as weight loss, unplanned delays in completing treatment, or hospitalization during treatment were the measures. Field size was a significant factor for mandible complications, but not for muscle or mucosa. CONCLUSION: The radiobiological characteristics of bone and muscle were those characteristic of other late-responding tissues, whereas late sequelae in mucosa had radiobiological parameters similar to those for acute responses. Field size was a significant factor for bone complications but not for others.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

Behavioral and neurochemical sequelae in young rats of antenal hypoxia.

To test the hypothesis that perinatal hypoxia may have postnatal consequences via à vis learning memory, and neurochemical sequelae, we exposed pregnant Sprague-Dawley rats to 10.5% O2 for 4 h per day (0800-1200 h) or continuously from gestional day E15 to E20. On E20 we quantified ornithine decarboxylase activity and polyamine concentrations in fetal brain. We also conducted behavioral tests from postnatal day P3 to P110. Relatively mild antenatal hypoxia resulted in altered learning, memory, and delayed maturation of early developmental sensorimotor function. These behavioral changes disappeared at various postnatal ages, depending on the function. Perinatal hypoxia also altered the pharmacological response to dopaminergic drugs. In addition, antenatal hypoxia feminized a male nonreproductive sexual behavior, that of saccharin preference. Acute hypoxia also resulted in an increase in the enzyme ornithine decarboxylase and polyamines, which may affect brain development.

Animals↗
PubMed1992

Development of the brainstem auditory pathway in low birthweight and perinatally asphyxiated children with neurological sequelae.

Low birthweight (LBW) and perinatal asphyxia are known to be high-risk factors for a number of neurodevelopmental deficits. In this study, we analyzed brainstem auditory evoked response (BAER) in 18 LBW and 36 perinatally asphyxiated children with non-progressive neurological sequelae after the age of 6 months to inspect and compare the long-term influence of LBW and perinatal asphyxia on the brainstem auditory pathway. The typical changes in the BAER of children born with LBW were slightly shorter III-V interpeak interval and smaller III-V/I-III interval ratio than normal controls. On the contrary, the abnormalities in the BAER of 36 children surviving perinatal asphyxia were characterized by a reduction of the amplitude of wave V with normal intervals. This discrepancy in the BAER between the children born with LBW and those with perinatal asphyxia implies that the two high-risk factors exert different long-term influences on the development of the brainstem auditory pathway. It is hypothesized that these characteristic changes may be indicative of a major influence of LBW on the generators contributing to wave III and that of asphyxia on the generators contributing to wave V. An increase in response threshold with abnormal latency-intensity function was found in 11% of the LBW children and 19% of the asphyxiated children, suggesting that sensorineural hearing impairment occurred more frequently in children surviving perinatal asphyxia than in those born with LBW. Follow-up study demonstrates that the abnormalities in the brainstem auditory pathway of LBW and asphyxiated children after the age of 6 months is likely to be persistent.

Asphyxia Neonatorum↗
PubMed1991

The physician's responsibilities: residua and sequelae.

Cardiologists assuming responsibility for adults with congenital heart disease must have knowledge of electrophysiologic, valvular (native valves), prosthetic (valves, patches and conduits), ventricular (especially chamber function), vascular (especially elevated pulmonary vascular resistance) and noncardiovascular residua and sequelae. Acquired cardiac and noncardiac diseases coexist in older adults with postoperative congenital heart disease and add to the physician's responsibilities.

Adult↗
PubMed1993

Sudden death in a young adult: sequelae of childhood Kawasaki disease.

A case of sudden cardiac death in a young adult secondary to sequelae of childhood Kawasaki disease is presented. At autopsy, proximal coronary artery aneurysms typical of Kawasaki disease with recent and remote myocardial infarction was found. Although the acute diagnosis and management of Kawasaki disease has received attention in recent literature, little has been written about the implications of the disease in long-term survivors. Serious morbidity and mortality many years after the acute phase of the disease can occur. Because of the relatively recent recognition of the disease, an undetermined population of patients with previously unrecognized Kawasaki disease exists. Young patients with previous Kawasaki disease may have severe stenotic coronary disease that may be asymptomatic and present with sudden cardiovascular symptoms or death. Acute care physicians should be cognizant of these issues and should seek specific information regarding childhood illnesses when evaluating the young patient with acute cardiovascular symptoms.

Adolescent↗
PubMedDate not supplied

Chondritis of the ear: a late sequela of deep partial thickness burns of the face.

Chondritis of the ear is a late sequela of deep partial thickness burns of the face. It is the purpose of this article to describe two patients who came to the emergency department 21 days and 35 days after sustaining deep partial thickness burns of the face from explosions. The patients were hospitalized for incision and drainage of the infected wound that included excision of the infected cartilage complemented by systemic antibiotic therapy.

Adolescent↗
PubMedDate not supplied

Physiologic sequelae of prematurity: the nurse practitioner's role. Part II. Retinopathy of prematurity.

Retinopathy of prematurity is a common complication in the treatment of premature birth. This article, the second in a series on the physiologic sequelae of prematurity, presents the pathophysiology of this condition, as well as the effects on the child's growth and development. Common problems faced by these children and their families are discussed, and parental counseling needs are presented.

Child Development↗
PubMedDate not supplied

Physiologic sequelae of prematurity: the nurse practitioner's role. Part IV. Anemia.

Anemia in the immediate newborn period may be caused by hemolysis, by a failure of red-cell production, or by a combination of both. However, anemia of prematurity often is the result of hemolysis, of a lack of erythropoietin, and/or of nutritional deficits. Transfusion without a search for the cause may obscure the underlying pathology of the anemia. Because severe anemia can be life-threatening, prompt diagnosis and treatment are required. In this article, the fourth of a series of articles on the sequelae of prematurity, a discussion of the pathophysiology, signs and symptoms, data collection, treatment modalities pertinent to the anemia of prematurity, and parental education are discussed.

Anemia, Neonatal↗